Worldwide, the leading cause of death in patients younger than the age of 44 years is trauma. In 2013, trauma claimed over 2.1 million years of potential life with direct costs of over $700 billion in the United States alone. These staggering numbers do not take into consideration the additional expense of disability or the lost financial productivity of survivors (1). The cost to society of lost productivity alone is approximately four times the direct medical expenses (2).

Great strides have been made toward improving trauma care in the United States. Integrated systems that initiate resuscitation at the site and expedite transfer to specialized centers have helped save lives. And these systems continue to evolve. In the past, the trauma patient was best cared for in a trauma operating room (OR). A primary goal of trauma care was to expedite transfer from the field to the OR where diagnostics and definitive care could be provided. Over the past decade however, primarily due to the deployment of helical computed tomography (CT) in the trauma bay, the path followed by the trauma patient now detours through CT. Diagnosis and triage have moved from the OR to the CT scanner. Following CT diagnosis, expedited directed care based on imaging findings follows—orthopedic, neurosurgical, laparotomy, or interventional radiology (IR) embolotherapy. Resuscitation moves with the patient. Whole-body CT scanning prior to intervention in hemodynamically unstable patients and patients requiring emergency bleeding control is associated with significantly better survival than direct transfer to surgery on arrival (3). Even the distance between the trauma bay and the CT machine independently predicts survival (4).

IR has evolved in parallel since 1972 when Margolies et al. first described embolization therapy for management of pelvic trauma. Techniques and devices to manage trauma victims nonoperatively have been validated, and the scope of care provided has expanded. IR has become an indispensable member of the trauma team, with the capability to rapidly address exsanguinating hemorrhage throughout the body without the inherent delay and morbidity of open exploration. The old bromide that unstable exsanguinating trauma patients go to the OR and the stable ones to IR no longer applies. When the IR space is appropriately configured and staffed with an experienced, trained team, the decision for IR versus OR should be based on diagnosis, not acuity. Leading trauma centers increasingly recognize the importance of image-guided medicine and the need to provide the resources and expert practitioners able to effectively integrate IR in to the trauma care environment.

The initial steps of intervention for trauma are similar regardless of the location of injury. General considerations are discussed first. The details involved in treating specific types of traumatic injury—abdominal including splenic, hepatic, and renal; pelvic; lumbar artery; and extremity are then discussed, along with their complications.