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. 2025 Sep 22;42(4):432–438. doi: 10.1055/s-0045-1811518

Rapid Response to Traumatic Vascular Injury: An Institutional Code Angio Protocol

Shriya Veluri 1, Dylan Later 2, Jorge Lopera 2, John Walker 2,✉
PMCID: PMC12614749  PMID: 41245613

Abstract

Traumatic vascular injuries are a major cause of death and disability, especially in those under 45. Vascular and interventional radiology (VIR) has transformed management, offering minimally invasive options. This paper examines the implementation of a Code Angio protocol at a level I trauma center to expedite response times for such injuries by VIR. Initiated in August 2014 at University Hospital in San Antonio, Code Angio uses automated alerts to simultaneously notify a multidisciplinary team—including VIR, trauma surgery, anesthesia, and operating room staff—when trauma patients meet vascular injury criteria. After implementation, Code Angio response times decreased, and the need for urgent laparotomies for hemorrhage control was reduced. From 2019 to 2024, 1,447 cases were recorded, with Code Angio facilitating rapid VIR team activation, mostly within 60 minutes. The survival rate for Code Angio patients was higher than with surgery alone. Subgroup analysis showed Code Angio's routine use in specific injuries, helping reduce invasive surgeries and optimizing resource use. Rapid response VIR protocols like Code Angio improve patient outcomes, resource use, and healthcare efficiency. Future efforts will focus on better integration with trauma guidelines, identifying workflow delays, and continuous protocol refinement for seamless coordination.

Keywords: angioembolization, trauma, vascular injury, rapid response, guidelines

Trauma remains a significant global health concern, with profound impacts on mortality, morbidity, and healthcare economics. Traumatic injury accounts for approximately 10% of deaths worldwide annually, and it is the leading cause of mortality in individuals aged 45 years and younger. 1

In particular, traumatic vascular injuries can lead to severe bleeding and life-threatening complications if not promptly addressed. Blunt trauma accounts for a significant proportion of injuries requiring intervention in the United States. Traditionally, surgical interventions were the mainstay of treatment for these injuries; however, the emergence of vascular and interventional radiology (VIR) has revolutionized the management of traumatic vascular injuries. For instance, in cases of splenic injury from blunt trauma, approximately 12 to 15% of patients fail nonoperative management, prompting the use of angioembolization. Splenic salvage rates with embolization exceed 85%, demonstrating its effectiveness in managing such injuries. 2 Additionally, liver trauma—the second most common abdominal injury from blunt force—often necessitates embolization, with technical success rates ranging from 85 to 100% for severe cases. 3

The incorporation of VIR techniques into trauma care first began in the early 1970s, with the first mention of their use being in 1972: autologous blood clots were utilized to embolize hemorrhaging arteries in pelvic trauma. 4 This technique marked the beginning of a new era in hemorrhage control, offering a less invasive alternative to open surgery. Since then, VIR has undergone rapid evolution in both techniques and technology. Modern VIR procedures utilize advanced imaging modalities, such as digital subtraction angiography (DSA), to precisely diagnose and localize vascular injuries. Additionally, a wide array of embolic materials, including coils, particles, and liquid embolic agents, as well as covered stents, have been employed to allow for more targeted and effective control of bleeding (see Fig. 1 ).

Fig. 1.

Fig. 1

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Various embolization materials used in angioembolization procedures. ( A ) Depicts absorbable gelatin. ( B ) Shows two sizes of detachable coils. ( C ) Shows liquid embolic (glue). ( D ) Shows particles. ( E ) Demonstrates a vascular plug.

These technologies and techniques—including imaging modalities such as CT angiography, fluoroscopy, and DSA—facilitate a comprehensive, multidisciplinary approach to patient management. In addition to accurately diagnosing the site and severity of vascular injuries, VIR also plays a critical role in the nonoperative management of hemorrhage and enables the optimization of preoperative conditions, thereby reducing the need for unnecessary surgical interventions. 5 6 7 This capability is particularly vital in complex trauma cases where multiple systems may be affected, requiring a coordinated effort between trauma surgeons, interventionalists, and critical care specialists to devise the most effective treatment plan. 8 9 The collaborative environment fostered by the integration of VIR into trauma care ensures that patients receive tailored interventions that prioritize their safety and recovery, ultimately improving outcomes and minimizing the long-term impact of traumatic injuries on their health and quality of life.

Several studies have demonstrated associations between delay in VIR response times and poor patient outcomes in trauma care, with societal position statements reflecting such a link. 10 11 12 13 For instance, a 2007 National Confidential Enquiry into Patient Outcome and Death report from the UK highlighted the low use of and delays in accessing IR and its association with higher mortality rates, highlighting deficiencies in trauma care. 14 Additionally, the UK National Institute for Health and Care Excellence has established guidelines that emphasize the importance of rapid access to VIR services, particularly for patients with active pelvic, solid organ, and arterial hemorrhage. 15 In the United States, the American College of Surgeons Committee on Trauma (ACS-COT) and Society of Interventional Radiology (SIR) mandate that the VIR team be available within 60 minutes of notification to perform angiography and embolization. 16 17 These guidelines collectively underscore the critical nature of 24/7 VIR availability and rapid response times in trauma care.

Identifying a Solution

To align with these recommendations and guidelines, institutional protocols for multidisciplinary collaboration can be implemented to improve response times to manage potential life-threatening injuries. These approaches generally optimize communication systems, team composition, and quality improvement measures. In some institutions where such multidisciplinary protocols have been implemented, a median response time of 28.5 minutes has been reported. 18 Additionally, a 10-year experience with a multidisciplinary institutional protocol for traumatic pelvic ring fractures showed a significant reduction in annual mortality rates from 7.8 to 2.4%, which was attributed to the role of timely angioembolization in the protocol. 19 Such findings highlight the importance of having a well-defined protocol for rapid VIR response and involving VIR in the creation and implementation of these protocols in level I and II trauma centers.

The Code Angio Activation Protocol at University Hospital (UH) in San Antonio is the local trauma response protocol implemented in August 2014 as a collaboration between the IR, trauma, and anesthesia services (see Fig. 2 ). Using an automated paging system, Code Angio is activated for patients with unstable abdominal and pelvic trauma, solid organ injuries, and other cases with CT findings of active extravasation or signs of vascular injury. The Code Angio team consists of a VIR attending physician, a fellow or a senior resident, and a dedicated IR technician; trauma surgery attending physician and/or resident; anesthesia services; and operating room (OR) staff, all of whom are alerted simultaneously. The alert contains basic information to include the current patient location and the phone number of the activator. Code Angio cases are typically performed in a hybrid OR that is equipped with standard angiography procedure equipment to allow for a combination of open surgical and endovascular techniques as needed. Overall, rapid mobilization, concurrent actions, and a hybrid space allow for reduced time to intervention.

Fig. 2.

Fig. 2

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Code Angio protocol used at University Hospital, San Antonio, Texas.

Following the institutional Code Angio protocol implementation, average VIR response times decreased from 51.3 minutes in the preceding year to 38.5 minutes by 2018. In addition, the rate of urgent laparotomies for hemorrhage control showed a concurrent reduction from 15.1 to 9.7%.

Between 2019 and 2024, a total of 1,447 trauma cases were recorded. Blunt liver injuries were the most common, accounting for approximately 50% of all cases ( n  = 730), followed by blunt spleen injuries (46.6%, n  = 674), blunt kidney injuries (19.7%, n  = 285), and blunt pelvic injuries (10.6%, n  = 154). Nonoperative management was the most frequently utilized approach (64%, n  = 926), reflecting the growing emphasis on conservative treatment strategies for stable trauma patients. However, surgical management (36%, n  = 521) played a critical role in managing complex cases requiring rapid vascular intervention. The Code Angio protocol was utilized in 38% of surgical cases ( n  = 198), consistently facilitated by prompt activation of the VIR team. Specifically, 89.4% ( n  = 177) of Code Angio activations occurred within 60 minutes, continuing trends that were established in the initial years of protocol implementation.

Subgroup analysis reveals that the Code Angio protocol is routinely utilized in managing specific types of injuries. For example, splenic artery embolization accounted for the majority of arterial embolization performed under the protocol (53 Code Angio cases vs. 36 surgical cases), emphasizing its importance in controlling hemorrhage from blunt splenic trauma. Similarly, hepatic artery embolization (22 Code Angio cases vs. 11 surgical cases) and renal artery embolization (9 Code Angio cases vs. seven surgical cases) were more commonly performed under the Code Angio protocol for traumatic liver and kidney injury, respectively. Pelvic artery embolization (10 cases) has also proven indispensable for managing complex pelvic injuries (see Fig. 3 for examples of blunt trauma acted upon via the Code Angio system).

Fig. 3.

Fig. 3

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( A ) Demonstrating a case of splenic trauma with active extravasation (denoted by the arrow); ( B ) a similar case of hepatic trauma with active extravasation; and ( C ) a pelvic trauma denoting active extravasation.

Additionally, the protocol seems to have reduced the frequency of invasive surgical procedures. For example, splenectomy rates were lower in patients managed with Code Angio compared with those undergoing surgery (7 vs. 15 cases, respectively, over 6 years). Similarly, nephrectomies were infrequent in the Code Angio group, with only one case recorded compared with four in the surgical group. While surgery remained the primary approach for orthopedic pelvic traumas, Code Angio played a crucial role in augmenting pelvic fixation by providing hemodynamic stabilization in 24 out of 126 cases. Further, the average length of stay (LOS) for Code Angio patients remained comparable to surgical patients, averaging 15 days, while nonoperative management had a shorter LOS of 9 days. The findings are representative of a type of symbiotic relationship shared between our trauma surgery team and interventional radiology, in which cases that have historically been managed surgically have now shifted to primarily involve IR first, when feasible. Note is made, however, that mortality differences seen may be in relation to injury severity scores (ISS). In essence, surgical patients may have higher ISS requiring immediate surgical intervention versus angiographic management. Further extrapolation of data would be needed to make a definitive correlation.

Evidence from the transfusion data suggests that the Code Angio protocol has the potential to optimize resource utilization. Patients treated with angiographic embolization required an average of 4,421 mL of transfused blood products, higher than nonoperative management (1,502 mL) but generally comparable to surgical interventions (3,541 mL). Despite higher transfusion volumes, the survival rates for Code Angio patients remained superior, suggesting effective management of these critical cases. Moreover, when factoring in the reduced need for additional surgeries and shorter recovery times associated with minimally invasive techniques, the protocol likely contributes to overall consistent improvement in outcomes and resource utilization trends.

Discussion

Benefits of Rapid Response VIR Protocols

The implementation of rapid response VIR protocols in trauma care has demonstrated significant improvements in patient outcomes, resource utilization, and overall healthcare system efficiency. Over the past decade, time-conscious guidelines like the Code Angio protocol have been developed by various groups in response to the ACS-COT and SIR position statements, achieving remarkable improvements in time-to-treatment metrics. For instance, a study by Kim et al reported a reduction in median time to angiography to under 30 minutes following the implementation of a refined trauma activation protocol, similar to findings from the Code Angio protocol. 20 Matsumoto et al also utilized the concept of “damage control interventional radiology (DCIR)” when designing their protocol, which has resulted in decreased times to obtain femoral access and complete embolization. 6

Moreover, the increased utilization of endovascular techniques has been associated with improved patient outcomes, particularly in cases involving thoracic and abdominal injuries (see Fig. 4 for examples of endovascular trauma intervention). A recent analysis of the American Association for the Surgery of Trauma (AAST) Prospective Observational Vascular Injury Treatment (PROOVIT) registry revealed that endovascular repair was associated with significantly lower mortality rates compared with open repair for thoracic (5% vs. 46%) and abdominal injuries (15% vs. 38%). 21 These findings concur with results from the UH Code Angio protocol and underscore the life-saving impact of timely VIR interventions in trauma care.

Fig. 4.

Fig. 4

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An example of iliac artery hemorrhage (denoted by arrow A ), which was treated with a covered stent ( B ). ( C ) Demonstrates treated vascular injury with a patent iliac artery.

The implementation of these protocols has streamlined the involvement of VIR through various mechanisms, including defined criteria for protocol activation, closed-loop communication, dedicated hybrid ORs, and multidisciplinary collaboration. By creating a clear framework for when and how to involve VIR in trauma cases, all key players are aligned in their understanding of when VIR intervention is necessary, and hence, potential delays in care are minimized. 22 Closed-loop communication systems, such as those utilized in the Code Angio protocol as well as the algorithm described by Kim et al, ensure that critical information is not only transmitted but also received and acknowledged, reducing the risk of errors and enhancing overall team performance. 20 To further promote rapid response and improved patient outcomes, optimizing the physical environment through a dedicated hybrid OR and appropriately trained OR personnel allows for seamless transitions between surgical and interventional procedures. It has also been shown to be associated with earlier hemorrhage control and fewer early blood transfusions, infectious complications, and ventilator days. 23

Challenges in Protocol Implementation

Despite the numerous benefits of having a rapid response VIR protocol, key challenges in its implementation may arise. Recommendations to have an angiography suite and a VIR team available at all times can be difficult to achieve, specifically in smaller or rural hospitals with limited resources. For such facilities, developing protocols to postpone elective procedures during trauma activations is crucial and highlights the need for flexible resource management and potentially the development of regional trauma networks to ensure adequate coverage. Additional efforts that can be taken to promote multidisciplinary collaboration include the creation of joint training curricula and the standardization of protocols across specialties. The increasing role of VIR in trauma care necessitates specialized training for interventionalists and their teams. This training should encompass not only technical skills but also crisis management, efficiency, and effective communication in high-acuity scenarios. By developing shared educational programs, healthcare institutions can foster a culture of collaboration and mutual understanding among different specialties. The standardization of protocols across specialties also reduces redundancies and variability in treatment approaches, ensuring that all team members are familiar with the procedures and expectations in trauma cases that require VIR intervention. Thus, increased emphasis on a multidisciplinary approach not only improves the quality of care but also enhances the efficiency of these multidisciplinary teams in high-acuity trauma situations. 22

To further improve the efficiency of trauma care and facilitate the role of VIR, it is important to better integrate VIR protocols with existing trauma management guidelines and identify common delays in the workflow. This integration requires a careful incorporation of the evolving capabilities of VIR and a greater emphasis on multidisciplinary collaboration. Other issues like patient transfer times, equipment preparation, or communication bottlenecks must also be adequately addressed. Regular multidisciplinary meetings and continuous protocol refinement are essential to ensure seamless coordination between different specialties.

Challenges to the Existing Code Angio Protocol

While implementation of the Code Angio system has shown overall good outcomes, challenges have arisen that are worth considering. Most of the issues encountered revolve around nontrauma care services learning of the rapid response system, yet not fully understanding the nuances of coordinating the response.

First, the paging system is an all-or-none system for alerting both the VIR technologist and the VIR proceduralists. When the alert is intercepted while away from the hospital, all involved parties proceed to the hospital, often before knowing details of the case. In some instances, other services have only wanted support of a VIR technologist for their own on-call case and have activated the “Code Angio” system, leading to the wrong personnel responding. Other scenarios have arisen where critical care services need a “stat” VIR consult; however, instead of paging or calling the on-call service numbers, they activate the Code Angio system, again prompting immediate mobilization of the respondents. In some cases, patients meet “Code Angio” urgencies, as in the case of an acute GI bleed, and in these situations, the nontrauma ICU services or GI service consults have activated the Code Angio system. While this may seem an appropriate action, these services are not familiar with the OR protocols, nor are they part of the formal Code Angio system. As such, they fail to appropriately coordinate further care with intercepting services, and the rapid orchestration fails.

To further elaborate, the Code Angio system is predicated on the trauma surgeons having a direct process to transport a critical patient from the trauma bay to the OR, such that when a Code Angio is activated, they are mobilizing the patient to the hybrid OR/IR suite. When a nonsurgical team activates the code, they are awaiting VIR to present and subsequently coordinate mobilizing the patient. This leads to overutilization of resources in the face of delayed patient care. In similar cases, the suspected acute bleed or other VIR emergencies are not well understood, and the VIR operators arrive without full knowledge of the next steps. A common example is that of a GI bleed in patients where the source may be related to variceal versus arterial in origin. In such cases, the source can be better assessed by stabilizing the patient, sometimes with the need for GI temporizing the patient, followed by multi-phase imaging to elucidate the bleeding source. Otherwise, the operator may have to make a decision that leads to unnecessary procedures—such as angiography prior to a TIPS or BRTO—and delay of treating the source. Other bleed scenarios resulting in Code Angio activation are stable spontaneous bleeds that often respond to anticoagulation reversal and resuscitation, which will have negative angiographic findings. Still, other emergent scenarios like pulmonary embolism have resulted in Code Angio activation, although this particular entity has its own code response pathway for appropriate patient triage.

To mitigate and limit unnecessary or poorly activated Code Angio responses, education to other services has been the primary mode of action. The algorithm for nontrauma Code Angio activations exists; however, they start with a VIR consult with the consultant then responsible for activation. This is important because the consultant knows they must also start the process of notifying the OR board runner and the anesthesiologist with vital information to begin critical information handoffs that accompany patient transfer. Emphasis on radiology being responsible for activating the Code Angio system is frequently reinforced, and even in cases of trauma activation, the ED radiologist is part of the activation process.

While overuse can pose issues, similarly, a lack of VIR response can lead to system failures. It is important for each member of the responding team to have a backup phone or pager number listed and available in the event their primary mode fails to notify appropriately. The automated paging system we utilize sends multiple alerts and escalates to backup numbers until the responder appropriately closes the loop via prompts in a text or the automated phone call.

Research Gaps and Future Directions

While several studies have demonstrated the benefits of rapid response IR protocols in trauma care, there is a need for large-scale, multicenter databases and studies to validate these findings across diverse healthcare settings. Such studies could provide more robust evidence to support the widespread implementation of these protocols and help identify best practices that can be standardized across different institutions. Much of the existing research also focuses on immediate outcomes, such as mortality rates and time-to-treatment metrics. However, there is a significant opportunity to evaluate long-term outcomes, including functional status, long-term complications, quality of life, and economic impacts. More specifically, while VIR has shown promise in managing various trauma scenarios, there is a need for more targeted research on its efficacy for specific injury patterns. The increasing use of endovascular techniques for thoracic and solid organ abdominal injuries, as evidenced by the AAST PROOVIT registry data, warrants further investigation. Studies focusing on the comparative effectiveness of VIR versus traditional surgical approaches for different injury types could help refine treatment algorithms and improve patient outcomes. 21 Understanding these data and trends could provide a more comprehensive view of the benefits of VIR in trauma care and help justify the resources required for implementation.

Future Directions of VIR in Trauma Care

As the field of interventional radiology in trauma care continues to evolve, several emerging technologies and approaches show promise for enhancing patient outcomes and streamlining care delivery. One of the key areas of advancement is the continued evolution of imaging technologies and procedural techniques. The integration of advanced imaging modalities is expected to enhance the precision and efficacy of VIR procedures, allowing for better visualization and targeting of injuries. For example, while angiographic C-arms are common in hybrid ORs, 3D rotational DSA is a newer technology with image reconstruction abilities that have been shown to reduce the incidence of false negatives in identifying bleeding vessels (see Fig. 5 ). 24 25

Fig. 5.

Fig. 5

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Hybrid OR/IR room at University Hospital, San Antonio, Texas.

There have also been new developments in embolic agents used in angiographic hemorrhage control. Commonly used mechanical devices like coils and plugs, as well as some temporary agents such as dissolved gelatin sponges, rely on the patients' coagulation cascade to carry out their mechanism of action. 26 In coagulopathic patients, newer liquid embolic agents like N-butyl cyanoacrylate glue and ethylene vinyl alcohol copolymer have greater utility, although their cost and steep learning curve may limit their widespread use. 25 27 Other particles, including polyvinyl alcohol and embospheres, as well as conformable embolics, are gaining popularity for hemorrhage control.

Beyond the tools and techniques that can be utilized in acute trauma situations, advances in information technology and artificial intelligence (AI) can be incorporated into clinical care and algorithms to further increase the efficiency and effectiveness of VIR procedures. For example, voice-activated hands-free communication devices have improved turnaround and response times in comparison to telephones and pager systems. Cloud-based image sharing technologies and picture archiving and communications systems also allow for the rapid sharing of images to be shared across trauma systems and easier access to images to formulate procedural plans more efficiently. 28

In addition, AI and machine learning are being integrated into imaging systems to enhance image interpretation and decision-making processes. These technologies can analyze large datasets to identify patterns and assist in rapid diagnosis, which is critical in trauma settings. For instance, AI algorithms can quickly analyze CT scans to prioritize cases with life-threatening injuries, ensuring faster intervention for the most critical patients. Augmented reality and virtual reality technologies are also being developed to improve visualization during VIR procedures. These technologies can overlay digital information onto the real world, providing interventional radiologists with enhanced guidance during complex procedures. 29 In trauma care, this could mean real-time visualization of a patient's vascular anatomy superimposed on their body during an embolization procedure, improving precision and reducing procedure time.

Conclusion

The implementation of rapid response VIR protocols in trauma care has demonstrated significant improvements in patient outcomes, resource utilization, and overall healthcare system efficiency. Clear activation criteria, multidisciplinary approaches, efficient communication systems, and dedicated procedure spaces are a few essential components of successful rapid response protocols. To maintain and enhance the effectiveness of such protocols, institutions should then implement strategies for continuous quality improvement. Despite the clear benefits, challenges remain in the universal implementation of these protocols, particularly in resource-limited settings. Addressing these challenges requires flexible resource management and the development of regional trauma networks to ensure comprehensive coverage. Looking ahead, the integration of emerging technologies such as advanced imaging modalities, novel embolic agents, and AI holds great promise for further enhancing the precision and efficacy of VIR procedures. These innovations, combined with ongoing research and protocol refinement, will continue to drive improvements in trauma care delivery.

Funding Statement

Funding None.

Footnotes

Conflict of Interest None declared.

References

  • 1.Rhee P, Joseph B, Pandit V et al. Increasing trauma deaths in the United States. Ann Surg. 2014;260(01):13–21. doi: 10.1097/SLA.0000000000000600. [DOI] [PubMed] [Google Scholar]
  • 2.Salsamendi J, Quintana D, Kably I, Narayanan G.Special Considerations for Embolization in Trauma CasesEndovascular Today. Published online April 2013:42–49. Accessed August 8, 2025 at:https://evtoday.com/articles/2013-apr/special-considerations-for-embolization-in-trauma-cases
  • 3.Yu Q, Lionberg A, Zane K et al. Transarterial interventions in civilian gunshot wound injury: experience from a level-1 trauma center. CVIR Endovasc. 2023;6(01):47. doi: 10.1186/s42155-023-00396-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Margolies M N, Ring E J, Waltman A C, Kerr W S, Jr, Baum S. Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med. 1972;287(07):317–321. doi: 10.1056/NEJM197208172870701. [DOI] [PubMed] [Google Scholar]
  • 5.Zealley I A, Chakraverty S. The role of interventional radiology in trauma. BMJ. 2010;340:c497. doi: 10.1136/bmj.c497. [DOI] [PubMed] [Google Scholar]
  • 6.Matsumoto J, Lohman B D, Morimoto K, Ichinose Y, Hattori T, Taira Y.Damage control interventional radiology (DCIR) in prompt and rapid endovascular strategies in trauma occasions (PRESTO): a new paradigm Diagn Interv Imaging 201596(7-8):687–691. [DOI] [PubMed] [Google Scholar]
  • 7.Coccolini F, Stahel P F, Montori G et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5. doi: 10.1186/s13017-017-0117-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Ierardi A M, Duka E, Lucchina N et al. The role of interventional radiology in abdominopelvic trauma. Br J Radiol. 2016;89(1061):2.0150866E7. doi: 10.1259/bjr.20150866. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Vaidya R, Scott A N, Tonnos F, Hudson I, Martin A J, Sethi A. Patients with pelvic fractures from blunt trauma. What is the cause of mortality and when? Am J Surg. 2016;211(03):495–500. doi: 10.1016/j.amjsurg.2015.08.038. [DOI] [PubMed] [Google Scholar]
  • 10.Schwartz D A, Medina M, Cotton B A et al. Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention. J Trauma Acute Care Surg. 2014;76(01):134–139. doi: 10.1097/TA.0b013e3182ab0cfc. [DOI] [PubMed] [Google Scholar]
  • 11.Tesoriero R B, Bruns B R, Narayan M et al. Angiographic embolization for hemorrhage following pelvic fracture: Is it “time” for a paradigm shift? J Trauma Acute Care Surg. 2017;82(01):18–26. doi: 10.1097/TA.0000000000001259. [DOI] [PubMed] [Google Scholar]
  • 12.Tanizaki S, Maeda S, Matano H, Sera M, Nagai H, Ishida H. Time to pelvic embolization for hemodynamically unstable pelvic fractures may affect the survival for delays up to 60 min. Injury. 2014;45(04):738–741. doi: 10.1016/j.injury.2013.11.007. [DOI] [PubMed] [Google Scholar]
  • 13.Howell G M, Peitzman A B, Nirula R et al. Delay to therapeutic interventional radiology postinjury: time is of the essence. J Trauma. 2010;68(06):1296–1300. doi: 10.1097/TA.0b013e3181d990b5. [DOI] [PubMed] [Google Scholar]
  • 14.National Confidential Enquiry into Patient Outcome and Death . London, UK: NCEPOD; 2007. Trauma: Who Cares? A report of the National Confidential Enquiry into Patient Outcome and Death. [Google Scholar]
  • 15.National Institute for Health and Care Excellence.Major trauma: assessment and initial management. NICE guideline [NG39]London, UK: NICE; 2016. Updated2018. Accessed August 8, 2025 at:https://www.nice.org.uk/guidance/ng39
  • 16.American College of Surgeons Resources for Optimal Care of the Injured Patient 2022. Standards). Updated December 2023. Accessed November 18, 2024 at:https://www.facs.org/quality-programs/trauma/quality/verification-review-and-consultation-program/standards/
  • 17.Padia S A, Ingraham C R, Moriarty J M et al. Society of Interventional Radiology Position Statement on endovascular intervention for trauma. J Vasc Interv Radiol. 2020;31(03):363–36900. doi: 10.1016/j.jvir.2019.11.012. [DOI] [PubMed] [Google Scholar]
  • 18.Lopera J, Muir M. 2019. Rapid Response: Can IR achieve a 30-minute response time in major trauma? IR Quarterly. [Google Scholar]
  • 19.Chen H T, Wang Y C, Hsieh C C et al. Trends and predictors of mortality in unstable pelvic ring fracture: a 10-year experience with a multidisciplinary institutional protocol. World J Emerg Surg. 2019;14:61. doi: 10.1186/s13017-019-0282-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Kim C, Niekamp A, Pillai A S et al. Quality improvement project: improving interventional radiology response times for level I trauma embolization. J Am Coll Radiol. 2020;17(06):791–795. doi: 10.1016/j.jacr.2020.01.011. [DOI] [PubMed] [Google Scholar]
  • 21.Magee G A, Dubose J J, Inaba K, Lucero L, Dirks R C, O'Banion L A. Outcomes of vascular trauma associated with an evolution in the use of endovascular management. J Vasc Surg. 2023;78(02):405–4100. doi: 10.1016/j.jvs.2023.02.025. [DOI] [PubMed] [Google Scholar]
  • 22.Doke S, Karnatapu S, Karnatapu S et al. The significance of multidisciplinary approach to comprehensive trauma management. Ann Crit Care Emerg Med. 2023;4(01):106. [Google Scholar]
  • 23.Loftus T J, Croft C A, Rosenthal M D et al. Clinical impact of a dedicated trauma hybrid operating room. J Am Coll Surg. 2021;232(04):560–570. doi: 10.1016/j.jamcollsurg.2020.11.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Ringelstein A, Mueller O, Mönninghoff C et al. 3D rotational angiography after non-traumatic SAH. Rofo. 2014;186(07):675–679. doi: 10.1055/s-0033-1356325. [DOI] [PubMed] [Google Scholar]
  • 25.Jeph S, Ahmed S, Bhatt R D, Nadal L L, Bhanushali A. Novel use of interventional radiology in trauma. J Emerg Crit Care Med. 2017;1:27. [Google Scholar]
  • 26.Ahmed Y H. Interventional radiology in trauma: current role and prospects. Egypt J Radiol Nucl Med. 2024;55(01):171. [Google Scholar]
  • 27.Kolber M K, Shukla P A, Kumar A, Silberzweig J E. Ethylene vinyl alcohol copolymer (onyx) embolization for acute hemorrhage: a systematic review of peripheral applications. J Vasc Interv Radiol. 2015;26(06):809–815. doi: 10.1016/j.jvir.2015.02.025. [DOI] [PubMed] [Google Scholar]
  • 28.Banerjee A, Zosa B M, Allen D, Wilczewski P A, Ferguson R, Claridge J A.Implementation of an image sharing system significantly reduced repeat computed tomographic imaging in a regional trauma system J Trauma Acute Care Surg 2016800151–54., discussion 54–56 [DOI] [PubMed] [Google Scholar]
  • 29.Glielmo P, Fusco S, Gitto S et al. Artificial intelligence in interventional radiology: state of the art. Eur Radiol Exp. 2024;8(01):62. doi: 10.1186/s41747-024-00452-2. [DOI] [PMC free article] [PubMed] [Google Scholar]

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