Endovascular Suites and the Emergency Vascular Service

Hemorrhage control is an essential component of trauma care. Within modern trauma centers, there are often several methods that can be used to achieve hemostasis. These include operative and endovascular techniques, with the latter having acquired significant enthusiasm in recent years. Endovascular hemostasis has been traditionally performed by interventional radiologists in an interventional radiology (IR) suite. This is usually geographically remote to the operating room (OR) suites and rarely set up well for the resuscitation of critically unwell patients. Hybrid trauma operating rooms (HTORs) are one possible solution where IR and OR capability can be combined. These complex rooms include a fixed imaging system which can support fluoroscopy, angiography, and cone-beam computed tomography imaging. This approach promises to support the era of hybrid operating where patients can undergo multiple diagnostic and therapeutic interventions in one location. This has the potential to obviate the need for patient transfer between radiology and operative departments and can speed up care. However, HTOR utilization is complex, in terms of room design, imaging system, and staffing, which has limited the adoption of this technology. The aim of the chapter is to review these elements, discussing the advantages and disadvantages of different HTOR configurations.