The Role of Angiographic Interventions in Life-Threatening Traumatic Maxillofacial Bleeding

Abstract

Background: Intravascular embolization is an effective treatment option for cases of trauma induced massive maxillofacial bleeding (MFB). However, a viable guideline for endovascular treatment of MFB has not been established yet. This article investigates on parameters to distinguish suitable candidates of endovascular embolization among trauma victims with MFB, and discusses factors related to the clinical outcomes. Methods: From January 2015 to December 2018, 24 massive MFB patients underwent tranas-femoral angiography, and 16 of them proceeded with endovascular embolization (embolization group) while the other 8 patients only received angiography as no extravasation was observed (non-embolization group). We compared laboratory values (hemoglobin, pH, lactate, base excess) and clinical factors (blood pressure, age, initial GCS, time interval from trauma to intervention) related to the massive blood loss between the 16 of embolization group and the 8 of non-embolization group. The treatment results of angiographic intervention and mortality related factors were also compared to investigate factors related to treatment outcome.Results: Compared with non-embolization group, the patients of embolization group has a trend of lower hemoglobin (7.9 ± 3.6 g/dL vs 11.6 ± 2.3 g/dL, p = 0.047), lower base excess (-14.73 vs -6.9, p = 0.002), and lower systolic & diastolic blood pressure (100.5mmHg vs 59.9mmHg, 66.0 mmHg vs 30.9mmHg, respectively, p < 0.05). The overall mortality rate was 66.7% (87.5% in embolization group, 25% in non-embolization group). In the embolization group, there was no significant difference in all clinical and laboratory values between survivors and non-survivors. Conclusion: This study suggests initial hemoglobin, base-excess and low blood pressure as possible indicators to distinguish potential beneficiaries of facial embolization among MFB victims. However, it failed to find the viable prognosis factors to predict the clinical outcome of the embolization. Larger-scale prospective studies are needed in the future.