Renal pedicle vascular injuries are rare and occur in 1 to 4% of renal injuries. They are usually managed surgically though patients with traumatic renal artery dissection may be treated with endovascular stent placement, made possible with early CT diagnosis [72]. Patients with high grade injuries not involving the vascular pedicle but with CT findings consistent with active haemorrhage have been successfully managed with embolisation [69]. A recent 10- year review of the use of intervention in renal vascular

injury demonstrated a success rate of over 94% in patients undergoing angiography and embolisation as primary management (34.4% of patients) [73]. A further 23% of patients were managed conservatively and all those that required primary laparotomy did so for life-threatening haemorrhage or associated injuries. Technical failures requiring repeat angiography

and #JAK pathway randurls[1|1|,|CHEM1|]# embolisation can occur in up to 9.5%, and renal abscess in up to 5% [70]. Other rare but potential complications of renal embolisation include contrast nephropathy, renal infarction and haemorrhagic shock induced acute renal injury. With selective embolisation, the extent of a renal infarct can be significantly reduced resulting in excellent preservation of functioning Trichostatin A clinical trial renal tissue [70]. The choice of treatment depends on the condition of the patient and their injury, and the availability of interventional services. Superselective embolisation of renal artery branches is also the treatment of choice following iatrogenic trauma to the kidney [74]. Conclusion There is a paucity of good quality evidence for use of MDCT and/or embolization in trauma patients who are not completely stable consequently there is currently wide variation in practice with regard to the inclusion of angiography within treatment algorithms, both within

the UK and worldwide [4]. There is a need for greater access to MDCT and interventional radiology facilities including sufficient numbers of appropriately trained interventional radiologists Mirabegron and support staff to provide 24 hour cover at trauma centres. Once the infrastructure is in place prospective multicentre trials can be designed to determine optimum future treatment algorithms. Until then practice depends upon local facilities and availability and experience of surgeons and radiologists. NOM is now the treatment of choice for abdominal trauma with solid organ injury. Significant hollow organ or pancreatic injury is generally an indication for surgical management. Embolisation has an accepted role as an adjunct to NOM of abdominal trauma in haemodynamically stable patients with a contrast blush seen on arterial phase CT. It also has a role in the treatment of bleeding complications following operative intervention.