Embolization and vascular surgery

Vascular surgeons or interventionalists are on call to make decisions, frequently at inconvenient hours, under circumstances of complex clinical scenarios, solitude, lack of hospital resources, unfamiliarity with patients and constrained time. Contemporary trauma surgery focuses on correct priorities, the first of which is to save the patient’s life. Herein lies the fundamental difference between the two major types of vascular trauma, which is usually an immediate threat to life, whereas an injured extremity vessel is more often a threat to the viability of the limb. One of the fundamental principles to keep in mind when discussing vascular injuries in the context of multi-trauma is that bleeding and ischemia are different priorities. The amazing rapid progress in vascular surgery over the past decade, with the new imaging modalities and endovascular interventions, has translated into new concepts in the management of vascular trauma. The effectiveness of endovascular treatment of abdominal aortic aneurysm may be limited by persistent perfusion of the aneurysm sac (endoleak). Endoleaks that result in persistent systemic pressurization of the aneurysm or continued AAA expansion are believed to require treatment to prevent rupture. Selection of treatment method used is determined by the anatomic characteristic of the endoleak. Coil embolization, N-butyl cyanoacrylate infusion, thrombin, gelfoam or glue injection suggest that these technique for endoleak treatment after endovascular aortic repair (EVAR) are feasible and reliable.