# Vascular interventional radiology Vascular interventional radiology With the development and refinement of CT angiography - techniques, the diagnostic role of formal angiography has become limited. CT angiography is the first-line investigation for aortic trauma and for penetrating and non-penetrating peripheral vascular trauma. Endovascular techniques play an important role in the treatment of acute solid organ injuries, and the interventional radiologist should be consulted early in the decision-making Figure 8.32 Coronal computed tomography image of the body shows a grade V splenic injury (‘shattered spleen’; arrow) with vascular injury at the hilum and free /f_l uid around the spleen and liver (arrowhead). Figure 8.33 Coronal computed tomography demonstrating free /f_l uid around the liver. The upper pole of the right kidney and whole left kidney demonstrate no contrast uptake in keeping with acute vascular injury (arrows). In addition there is a distraction injury with lateral dislo - cation of the T11–T12 intervertebral junction (curved arrow). Figure 8.34 Sagittal reformats of computed tomography of the calcaneus in a patient following a fall illustrate a comminuted calcaneal fracture with intra- articular extension into the posterior facet of the subtalar joint (arrow). available embolic agents such as soluble gelatin sponge and microcoils, selective embolisation and reduction of blood flow to the injured segment can be achieved without causing infarc tion. Selective embolisation techniques are also suitable for the treatment of patients with pelvic fractures with ongoing blood loss and volume issues. With penetrating and non-penetrating extremity trauma, balloon occlusion and embolisation may be emplo yed to control haemorrhage, while the application of stent grafts can aid in re-establishing the circulation to the a ff ected extremity . (a) (b) Figure 8.35 Sagittal T1-weighted (a) and T2-weighted (b) magnetic resonance imaging of the spine demonstrate a burst fracture of L2 causing neural compression (arrows). Vascular interventional radiology With the development and refinement of CT angiography - techniques, the diagnostic role of formal angiography has become limited. CT angiography is the first-line investigation for aortic trauma and for penetrating and non-penetrating peripheral vascular trauma. Endovascular techniques play an important role in the treatment of acute solid organ injuries, and the interventional radiologist should be consulted early in the decision-making Figure 8.32 Coronal computed tomography image of the body shows a grade V splenic injury (‘shattered spleen’; arrow) with vascular injury at the hilum and free /f_l uid around the spleen and liver (arrowhead). Figure 8.33 Coronal computed tomography demonstrating free /f_l uid around the liver. The upper pole of the right kidney and whole left kidney demonstrate no contrast uptake in keeping with acute vascular injury (arrows). In addition there is a distraction injury with lateral dislo - cation of the T11–T12 intervertebral junction (curved arrow). Figure 8.34 Sagittal reformats of computed tomography of the calcaneus in a patient following a fall illustrate a comminuted calcaneal fracture with intra- articular extension into the posterior facet of the subtalar joint (arrow). available embolic agents such as soluble gelatin sponge and microcoils, selective embolisation and reduction of blood flow to the injured segment can be achieved without causing infarc tion. Selective embolisation techniques are also suitable for the treatment of patients with pelvic fractures with ongoing blood loss and volume issues. With penetrating and non-penetrating extremity trauma, balloon occlusion and embolisation may be emplo yed to control haemorrhage, while the application of stent grafts can aid in re-establishing the circulation to the a ff ected extremity . (a) (b) Figure 8.35 Sagittal T1-weighted (a) and T2-weighted (b) magnetic resonance imaging of the spine demonstrate a burst fracture of L2 causing neural compression (arrows). Vascular interventional radiology With the development and refinement of CT angiography - techniques, the diagnostic role of formal angiography has become limited. CT angiography is the first-line investigation for aortic trauma and for penetrating and non-penetrating peripheral vascular trauma. Endovascular techniques play an important role in the treatment of acute solid organ injuries, and the interventional radiologist should be consulted early in the decision-making Figure 8.32 Coronal computed tomography image of the body shows a grade V splenic injury (‘shattered spleen’; arrow) with vascular injury at the hilum and free /f_l uid around the spleen and liver (arrowhead). Figure 8.33 Coronal computed tomography demonstrating free /f_l uid around the liver. The upper pole of the right kidney and whole left kidney demonstrate no contrast uptake in keeping with acute vascular injury (arrows). In addition there is a distraction injury with lateral dislo - cation of the T11–T12 intervertebral junction (curved arrow). Figure 8.34 Sagittal reformats of computed tomography of the calcaneus in a patient following a fall illustrate a comminuted calcaneal fracture with intra- articular extension into the posterior facet of the subtalar joint (arrow). available embolic agents such as soluble gelatin sponge and microcoils, selective embolisation and reduction of blood flow to the injured segment can be achieved without causing infarc tion. Selective embolisation techniques are also suitable for the treatment of patients with pelvic fractures with ongoing blood loss and volume issues. With penetrating and non-penetrating extremity trauma, balloon occlusion and embolisation may be emplo yed to control haemorrhage, while the application of stent grafts can aid in re-establishing the circulation to the a ff ected extremity . (a) (b) Figure 8.35 Sagittal T1-weighted (a) and T2-weighted (b) magnetic resonance imaging of the spine demonstrate a burst fracture of L2 causing neural compression (arrows).