Angioembolization for pelvic hemorrhage control

Hauschild, Oliver; Aghayev, Emin; Heyden, Johanna von; Strohm, P. C.; Culemann, Ulf; Pohlemann, Tim; Suedkamp, Norbert P.; Schmal, Hagen

doi:10.1097/ta.0b013e318253b5ba

Cited by 77 publications

(51 citation statements)

References 18 publications

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“…Considerable force is required to disrupt or fracture the pelvic ring, and over 50% of pelvic fracture patients incur multiple associated injuries [2, 3]. Major pelvic fractures are life-threatening injuries, with reported mortality rates up to 46% [1, 2, 4–6].…”

Section: Introductionmentioning

confidence: 99%

Imaging and Endovascular Treatment of Bleeding Pelvic Fractures: Review Article

Wijffels

Verbeek

Ponsen

et al. 2018

Cardiovasc Intervent Radiol

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Pelvic fractures are potentially life-threatening injuries with high mortality rates, mainly due to intractable pelvic arterial bleeding. However, concomitant injuries are frequent and may also be the cause of significant blood loss. As treatment varies depending on location and type of hemorrhage, timely imaging is of critical importance. Contrast-enhanced CT offers fast and detailed information on location and type of bleeding. Angiography with embolization for pelvic fracture hemorrhage, particularly when performed early, has shown high success rates as well as low complication rates and is currently accepted as the first method of bleeding control in pelvic fracture-related arterial hemorrhage. In the current review imaging workup, patient selection, technique, results and complications of pelvic embolization are described.

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Section: Introductionmentioning

confidence: 99%

Imaging and Endovascular Treatment of Bleeding Pelvic Fractures: Review Article

Wijffels

Verbeek

Ponsen

et al. 2018

Cardiovasc Intervent Radiol

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“…In 3–9% of fractures a concomitant vascular damage is reported varying due to regional and socioeconomic factors [10, 22–24]. In this single-center cohort we identified an accompanying vascular damage in 7% of the fractures.…”

Section: Discussionmentioning

confidence: 92%

“…Especially rapid endovascular repair for bleeding control has evolved as primary option for certain clinical entities of vascular injury, like embolization in pelvic bleeding, stentgraft implantation in aortic transection or thoracic outlet vessel breach [22, 25, 31, 32]. However, mangled extremities remain a domain of open vascular repair (Fig.…”

Section: Discussionmentioning

confidence: 99%

Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

Gilbert

Schneemann

Scholz

et al. 2018

BMC Musculoskelet Disord

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BackgroundVascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed.MethodsThis comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group.Results: Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury.ConclusionVascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2333-y) contains supplementary material, which is available to authorized users.

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“…however, laparotomies are still necessary in some situations. In contrast, transcatheter arterial embolization (TAE) serves as an effective surgery alternative for retroperitoneal hemorrhage management [6–8]. Therefore, in addition to aggressive resuscitation, either a laparotomy or a TAE is usually needed for the hemostasis management of these patients.…”

Section: Introductionmentioning

confidence: 99%

The risk factors of concomitant intraperitoneal and retroperitoneal hemorrhage in the patients with blunt abdominal trauma

Yang

et al. 2015

World J Emerg Surg

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IntroductionIntraperitoneal and retroperitoneal hemorrhages may occur simultaneously in blunt abdominal trauma (BAT) patients. These patients undergo emergency laparotomies because of concomitant unstable hemodynamics and positive sonographic examination results. However, if the associated retroperitoneal hemorrhage is found intraoperatively and cannot be controlled surgically, then the patients require post-laparotomy transcatheter arterial embolization (TAE). In the current study, we attempted to determine the risk factors for post-laparotomy TAE.Materials and methodsPatients with concomitant BAT and unstable hemodynamic were retrospectively analyzed. The characteristics of the patients who underwent laparotomy or who required post-laparotomy TAE were investigated and compared. The Tile classification system was used to evaluate the pelvic fracture patterns.ResultsSeventy-four patients were enrolled in the study. Fifty-nine (79.7%) patients underwent laparotomy to treat intra-abdominal hemorrhage, and fifteen (20.3%) patients underwent additional post-laparotomy TAE because of concomitant retroperitoneal hemorrhage. Pelvic fracture was present in 80.0% of the post-laparotomy TAE patients. This percentage was significantly greater than that of the laparotomy only patients (80.0% vs. 30.5%, p < 0.001). Furthermore, 30 patients (40.5%, 30/74) had concomitant pelvic fracture diagnoses. Of these patients, eighteen (60%, 18/30) underwent laparotomy only, while the other twelve patients (40%, 12/30) required post-laparotomy TAE. Compared with the patients who underwent laparotomy only, more patients with Tile B1-type pelvic fractures (58.3% vs. 11.1%, p = 0.013) required post-laparotomy TAE.ConclusionRegarding BAT patient management, the likelihood of post-laparotomy TAE should be considered in patients with concomitant pelvic fractures. Furthermore, more attention should be directed toward patients with Tile B1-type pelvic fractures because of the specific fracture pattern and impaction force.

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Angioembolization for pelvic hemorrhage control

Abstract: Therapeutic study, level IV.

Cited by 77 publications

References 18 publications

Imaging and Endovascular Treatment of Bleeding Pelvic Fractures: Review Article

Imaging and Endovascular Treatment of Bleeding Pelvic Fractures: Review Article

Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

The risk factors of concomitant intraperitoneal and retroperitoneal hemorrhage in the patients with blunt abdominal trauma

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