Angiography and Embolization in the Management of Bleeding Pelvic Fractures

Vaidya, Rahul; Waldron, Jacob; Scott, Alesha N.; Nasr, Kerellos

doi:10.5435/jaaos-d-16-00600

Cited by 90 publications

(88 citation statements)

References 40 publications

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“…However, pelvic arterial bleeding accounts for up to 15% of bleeding associated with pelvic fractures; this type of bleeding is more threatening than venous bleeding [2, 9, 10]. The most often identified sources of arterial bleeding are the internal iliac artery (IIA) and its branches; patients with pelvic arterial bleeding usually present with systolic blood pressure (SBP) less than 90 mmHg, need more than 2000 mL of fluid resuscitation, and receive more than 4 units of blood transfusion within 24 h [2, 11–13]. Transcatheter arterial embolization (TAE) is an effective way to aggressively manage arterial bleeding and has a success rate higher than 85% [5, 10, 14–21].…”

Section: Introductionmentioning

confidence: 99%

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Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture

Chou

et al. 2019

World J Emerg Surg

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Introduction While transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk. The purpose of the current study was to determine how time to TAE affects outcomes in patients with pelvic fracture in the emergency department. Methods From January 2014 to December 2016, the trauma registry and medical records of patients with pelvic fracture who underwent TAE were retrospectively reviewed. The relationship between the time to TAE and patient outcomes was evaluated. The characteristics of surviving and deceased patients were also compared to search for prognostic factors affecting survival. Results Eighty-four patients were enrolled in the current study. Among patients with pelvic fracture who underwent TAE, the overall mortality rate was 16.7%. There were positive relationships between the time to TAE and the requirement for blood transfusion and between the time to TAE and intensive care unit (ICU) length of stay (LOS). Nonsurviving patients were significantly older (57.4 ± 23.3 vs. 42.7 ± 19.3 years old, p = 0.014) and had higher injury severity scores (ISSs) (36.4 ± 11.9 vs. 23.9 ± 10.9, p < 0.001) than were observed in surviving patients. There was no significant difference in the time to TAE between nonsurviving and surviving patients (76.9 ± 47.9 vs. 59.0 ± 29.3 min, p = 0.068). The multivariate logistic regression analysis showed that ISS and age served as independent risk factors for mortality. Every one unit increase in ISS or age resulted in a 1.154- or 1.140-fold increase in mortality, respectively ( p = 0.033 and 0.005, respectively). However, the time to TAE serves as an independent factor for ICU LOS ( p = 0.015). Conclusion In pelvic fracture patients who require TAE for hemostasis, longer time to TAE may cause harm. An early hemorrhage control is suggested.

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Section: Introductionmentioning

confidence: 99%

“…Unfortunately, although the success rate of TAE is high, the mortality rates reported in patients receiving TAE range from 16% to 50% among previous studies [11, 22]. Deaths usually result from associated injuries and delayed TAE [7, 19, 22].…”

Section: Introductionmentioning

confidence: 99%

Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture

Chou

et al. 2019

World J Emerg Surg

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“…Selection of the optimal treatment of major hemorrhage in patients with pelvic fracture remains a challenge for trauma surgeons (1-7). Uncontrollable major hemorrhage is a major cause of mortality in patients with pelvic fractures (8)(9)(10)(11). Relatively aggressive measures are imperative to manage this serious pathophysiological status; blood transfusion is an effective protocol for the improvement of the hypovolemic status and the use of other supportive care measures, including external fixations, angiography and embolization, as well as pre-peritoneal pelvic packing, may also be effective (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…Uncontrollable major hemorrhage is a major cause of mortality in patients with pelvic fractures (8)(9)(10)(11). Relatively aggressive measures are imperative to manage this serious pathophysiological status; blood transfusion is an effective protocol for the improvement of the hypovolemic status and the use of other supportive care measures, including external fixations, angiography and embolization, as well as pre-peritoneal pelvic packing, may also be effective (8)(9)(10)(11). Previous studies have revealed that high-energy pelvic fracture is associated with a relatively higher blood transfusion frequency (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of blood transfusion to patients with pelvic fracture in the initial 6�h from injury

Qing

Wang

Ai³

et al. 2020

Exp Ther Med

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As part of the treatment of pelvic fracture, major hemorrhage poses a challenge for trauma surgeons. The aim of the present study was to evaluate the clinical outcomes of blood transfusion in the initial 6 h after pelvic fracture, and to define the blood transfusion volume required for each pelvic fracture type. A retrospective cohort study was performed on patients with pelvic fracture at a single Level I Trauma Centre over a 3-year period. A total of 1,297 patients were transported to our trauma centre within 2 h of injury and blood transfusion was administered in the initial 6 h after pelvic fracture. Review of the patients' medical records provided the initial pelvic radiographs and data from emergency department care. Clinical outcomes, including frequency of blood transfusion, blood transfusion volume, injury severity scores and mortality, were evaluated. All pelvic fractures were defined as closed fractures and patients were categorized according to the Arbeit fuer Osteosynthese (AO) classification system. Statistical methods were used to identify trends to provide guidance for clinical prediction. Complete data were available for 497 patients with pelvic fracture, 104 (20.9%) of which received blood transfusion. The blood transfusion volume in the initial 6 h ranged from 0 to 10,000 ml, with a mean of 1,213.94±1354.11 ml. The total mortality rate was 1.8%. Among the patients with C-type pelvic fractures, the frequency of blood transfusion was 59.0% and the mean volume was 2,191.30±1,740.93 ml. The mortality rate for C-type pelvic fractures was 11.43%. The B3 subtype of pelvic fractures had the highest transfusion frequency (53.6%), while the C3 subtype had the largest blood transfusion volume (5,700.00±4,666.90 ml). Patients with type A-C pelvic fractures had a progressively larger mean transfusion volume, transfusion frequency and mortality in the initial 6 h after pelvic fracture. The AO classification system was demonstrated to be a useful tool for the identification of pelvic fracture risk in the present study.

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“…Absorbable gelfoam particles, compared with permanent materials such as polyvinyl alcohol particles and trisacryl gelatin microspheres, are preferred because they are temporary embolic materials and without many complications. The complications of embolization for pelvic arteries include infection, necrosis of muscle or penis, nerve injury, bladder or ureteral infarction, bleeding or hemorrhage, bowel infarction, thigh or buttock claudication, and impotence (Vaidya et al, 2018). In this case, gelatin sponge and natural silk segments were used in order to preserve the normal erectile function of the patient.…”

Section: Discussionmentioning

confidence: 99%

Superselective Arterial Embolization of Arteriovenous Malformation of Internal Pudendal Artery, a Rare Cause of Hematuria: A Case Report

Qiu

Wei

et al. 2020

Am J Mens Health

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Arteriovenous malformation (AVM) is a common form of vascular malformation, an abnormal direct communication between an artery and a vein without passing through the capillaries. AVM may just present as hematuria without plain or other symptoms. The article presents a case of a 52-year-old male with gross hematuria diagnosed as AVM of internal pudendal artery, which was successfully managed with superselective arterial embolization using temporary embolization materials.

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Angiography and Embolization in the Management of Bleeding Pelvic Fractures

Cited by 90 publications

References 40 publications

Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture

Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture

Clinical outcomes of blood transfusion to patients with pelvic fracture in the initial 6�h from injury

Superselective Arterial Embolization of Arteriovenous Malformation of Internal Pudendal Artery, a Rare Cause of Hematuria: A Case Report

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