X-ray endovascular methods for diagnosis and treatment of complications of thoracic organ injuries caused by blast trauma

Background. In modern warfare, thoracic injuries account for approximately 4% of all combat surgical trauma cases, and according to data from the Anti-Terrorist Operation / Joint Forces Operation (ATO/JFO) in Eastern Ukraine, the incidence reaches 7.5–11.7%. In cases of penetrating chest wounds, the overall mortality rate can be as high as 10%. Combined thoracoabdominal injuries occur in 25% of cases. Pulmonary hemorrhage is a complication that leads to death in 70% of cases. Therefore, it is critically important to rapidly assess the patient’s condition and determine the source of bleeding – gastrointestinal or pulmonary – in order to choose the appropriate treatment strategy. In surgery, pulmonary bleeding can be controlled by various methods with different levels of invasiveness. At the current stage of minimally invasive surgery development, endovascular embolization ranks among the leading methods worldwide for controlling hemorrhage. This technique is used to stop pulmonary bleeding in a number of thoracic diseases. Purpose – optimization and improvement of treatment outcomes for wounded individuals with blast injuries through the use of minimally invasive endovideosurgical technologies and endovascular catheter techniques for managing complications of combat-related chest trauma during evacuation stages. The goal is to reduce surgical trauma during the provision of medical care to the wounded. Materials and Methods. The most commonly used diagnostic methods for pulmonary hemorrhage include chest X-ray, bronchoscopy, multidetector computed tomography (MDCT), and angiography. These methods are employed to identify the source of bleeding in order to ensure adequate hemostasis. Results. Pulmonary hemorrhages are well studied today. Epidemiological studies have shown that such hemorrhages are associated with gender, age, and lifestyle. Additionally, tobacco smoking is a significant contributing factor to the occurrence of pulmonary hemorrhages. In the clinical case described the patient, none of the aforementioned causes were the underlying reason for the patient’s pulmonary hemorrhage. The patient sustained a gunshot shrapnel wound to the chest with rib fractures and hemopneumothorax. Moreover, the patient had a number of additional complications, which posed significant challenges for hemorrhage control and stabilization. Managing patients with gunshot injuries is a complex task for surgeons. Gunshot wounds to the chest wall are associated with high morbidity and mortality due to the presence of vital organs in this area. The heart, lungs, ascending and descending aorta, superior and inferior vena cava, vertebrae, and spinal cord are all vulnerable in thoracic trauma. Complications include pneumothorax and hemothorax (as occurred in this case). However, there are currently no specific guidelines for the management of pulmonary hemorrhage in patients with combat-related lung trauma. The standard sequence of care follows the same principles as for pulmonary hemorrhages of other etiologies. Despite the complexity of this clinical case, timely and accurate diagnosis and identification of the bleeding source allowed for the selection of an effective hemostatic method – namely, endovascular embolization of the bronchial arteries. Once the likely sources of bleeding are identified, embolization is performed using microspheres, gelatin sponges, or coils [6–10]. Thanks to modern techniques, complications after bronchial artery embolization are rare, occurring in less than 1% of cases. Clinical Case No. 1 deserves special attention, as minimally invasive video endoscopic interventions were applied at all evacuation stages, and endovascular embolization of the bronchial arteries was successfully used to eliminate the complication – massive pulmonary hemorrhage – in a patient with a gunshot lung injury. Despite the complexity of the case, timely and adequate diagnosis using angiographic methods allowed for accurate localization of the bleeding source and the application of a minimally invasive hemostatic method. As a result, stable hemostasis was achieved, the patient’s condition was stabilized, and a positive recovery trend was observed. Accordingly, endovascular embolization of the bronchial arteries is the method of choice for managing pulmonary hemorrhage of various etiologies, including those resulting from combat-related lung injuries and their complications. Conclusions. Blast injuries are complex wounds that require rapid medical care and a comprehensive approach to each casualty. A high-quality assessment of the injured and the right approach to treatment can reduce injuries during surgical care. The use of minimally invasive video endoscopic operations and endovascular interventions for вlast injuries complications during evacuation will reduce the length of hospital stay and rehabilitation of the injured. The exclusivity of clinical case № 1 is that minimally invasive interventions (laparoscopic and thoracoscopic) were performed at all stages of evacuation and X-ray endovascular treatment of complications (pulmonary bleeding) of mine-blast trauma was performed.