Acute Complications of Patients With Pelvic Fractures After Pelvic Angiographic Embolization

Abstract

Background Hemodynamically unstable patients with a pelvic fracture and arterial pelvic bleeding frequently are treated with pelvic angiographic embolization (PAE). PAE is reported to be a safe and effective method of controlling hemorrhage. However, the loss of blood supply and subsequent ischemia from embolization may lead to adverse consequences. Objectives/purposes We sought to determine (1) the frequency and types of complications observed after PAE;(2) the mortality after PAE; and (3) the clinical factors associated with complications and mortality after PAE. Methods We conducted a retrospective case series descriptive study at a Level I trauma center. Using our institution's trauma registry, we isolated patients with pelvic fractures treated with PAE admitted between June 1999 and December 2007. Complications attributed to PAE occurring in the initial hospital stay were recorded. We identified 98 patients with pelvic fractures treated by PAE with an average hospital stay of 25.3 days. Results The complication rate was 11% and included six patients with gluteal muscle necrosis (6%), five with surgical wound breakdown (5%), four deep infections (4%), one superficial infection, two patients with of impotence (2%), and one with bladder necrosis. The mortality rate in the PAE group reached 20%. Bilateral embolization was performed in 100% of the patients with complications.

Pelvic trauma and vascular emergencies

“…Muscle necrosis with necrotizing cellulitis is only seen with bilateral nonselective embolization [60]. Notwithstanding the incidence of complications of bilateral non-selective embolization, it is both effective and fast to perform particularly in unstable injury victims.…”

Complicación vascular tras fractura de ramas pélvicas

“…Sin embargo, la pérdida sanguí-nea a la que se suma la isquemia debida a la embolización puede provocar complicaciones graves. Así, el trabajo de Matityahu et al 4 sobre 98 pacientes describe un 11% de complicaciones de las cuales un 6% fueron necrosis de musculatura glútea, un 5% presentó dehiscencia de sutura, un 4% infecciones profundas, 2% impotencia, una infección superficial y una necrosis de vesícula biliar. El riesgo de mortalidad de los pacientes embolizados alcanzó el 20%.…”

Traumatisme du pelvis et urgences vasculaires

“…Les nécroses musculaires avec dermo-hypodermite nécro-sante s'observent uniquement dans les embolisations non sélectives bilatérales [60]. La prévalence des complications de l'embolisation non sélective bilatérale ne doit effacer son efficacité et sa rapidité de réalisation, notamment pour les blessés instables.…”