Early embolization without external fixation in pelvic trauma

Tanizaki, Shinsuke; Maeda, S.; Hayashi, Hiroyuki; Matano, Hideyuki; Ishida, Hiroshi; Yoshikawa, Jun; Yamamoto, Toru

doi:10.1016/j.ajem.2010.11.032

Cited by 29 publications

(13 citation statements)

References 17 publications

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“…Similar improved outcomes with earlier embolization have also been documented with both traumatic pelvic and splenic injuries 42–46 . Only three articles in this study sufficiently separated outcomes for early versus late embolization patients 15, 21, 24 .…”

Section: Discussionsupporting

confidence: 70%

Outcomes and complications of angioembolization for hepatic trauma

Green

Bulger

Kwan

2016

Journal of Trauma and Acute Care Surgery

101

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Background The liver is one of the most frequently injured abdominal organs. Hepatic hemorrhage is a complex and challenging complication following hepatic trauma. Significant shifts in the treatment of hepatic hemorrhage, including the increasing use of angioembolization, are believed to have improved patient outcomes. We aimed to describe the efficacy of angioembolization in the setting of acute hepatic arterial hemorrhage, as well as the complications associated with this treatment modality. Methods A systematic review of published literature (MEDLINE, SCOPUS, and Cochrane Library) describing hepatic angioembolization in the setting of trauma was performed. Articles that fulfilled the predetermined inclusion and exclusion criteria were included. We analyzed the efficacy rate of angioembolization in the setting of traumatic hepatic hemorrhage as well as the complications associated with hepatic angioembolization. Results Four hundred and fifty nine articles were identified in the literature search. Of these, 10 retrospective studies and 1 prospective study met inclusion and exclusion criteria. Efficacy rate of angioembolization was 93%. The most frequently reported complications following hepatic angioembolization included hepatic necrosis (15%), abscess formation (7.5%), and bile leaks. Conclusion Although the outcomes of hepatic angioembolization were generally favorable with a high success rate, the treatment modality is not without associated morbidity. The most frequently associated major complication was hepatic necrosis. Rates of complications were affected by study heterogeneity and should be better defined in future studies.

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Section: Discussionsupporting

confidence: 70%

Outcomes and complications of angioembolization for hepatic trauma

Green

Bulger

Kwan

2016

Journal of Trauma and Acute Care Surgery

101

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“…[ 28 ] reported angiographic embolization effective in 95% of patients with major pelvic fractures or solid visceral organ injuries. This is supported by previous studies finding arterial hemorrhage arising from pelvic fracture[ 8 20 29 30 31 32 33 34 ] and solid organ injuries[ 22 35 36 37 38 39 40 ] amenable to management with angiography and embolization. Disadvantages to angiography are the transportation of a severely injured patient to the angiography suite and the availability of a skilled interventional radiologist and associated technical staff.…”

Section: Discussionsupporting

confidence: 83%

Mortality in trauma patients with active arterial bleeding managed by embolization or surgical packing: An observational cohort study of 66 patients

Froberg

Helgstrand

Clausen

et al. 2016

J Emerg Trauma Shock

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Objective:Exsanguination due to coagulopathy and vascular injury is a common cause of death among trauma patients. Arterial injury can be treated either by angiography and embolization or by explorative laparotomy and surgical packing. The purpose of this study was to compare 30-day mortality and blood product consumption in trauma patients with active arterial haemorrhage in the abdominal and/or pelvic region treated with either angiography and embolization or explorative laparotomy and surgical packing.Material and Methods:From January 1st 2006 to December 31st 2011 2,173 patients with an ISS of >9 were admitted to the Trauma Centre of Copenhagen University Hospital, Rigshospitalet, Denmark. Of these, 66 patients met the inclusion criteria: age above 15 years and active arterial haemorrhage from the abdominal and/or pelvic region verified by a CT scan at admission. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, mechanism of injury, ISS, Probability of Survival, treatment modality, 30-day mortality and number and type of blood products applied were retrieved from the TARN database, patient records and the Danish Civil Registration System.Results:Thirty-one patients received angiography and embolization, and 35 patients underwent exploratory laparotomy and surgical packing. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, ISS and Probability of Survival were comparable in the two groups.Conclusion:A significant increased risk of 30-day mortality (P = 0.04) was found in patients with active bleeding treated with explorative laparotomy and surgical packing compared to angiography and embolization when data was adjusted for age and ISS. No statistical significant difference (P > 0.05) was found in number of transfused blood products applied in the two groups of patients.

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“…Operative external fixation is also an effective method to stabilize the pelvis, but takes much longer than application of a pelvic binder or C-clamp and seems to have similar benefits. Therefore, in hemodynamically unstable patients, operative external fixation should be delayed until after angioembolization is complete [36,37]. In hemodynamically stable patients with evidence of ongoing hemorrhage and an unstable pelvic fracture, operative external fixation may be preferred over angioembolization.…”

Section: Controlling Pelvic Fracture-related Hemorrhagementioning

confidence: 99%

Angioembolization: Indications, Approach and Optimal Use

Klein

Kirton

2015

Curr Trauma Rep

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Angioembolization has revolutionized the management of pelvic-fracture-related hemorrhage. Along with pelvic immobilization and preperitoneal pelvic packing, angioembolization is an integral component in multidisciplinary algorithms for achieving hemostasis in severe pelvic trauma. Polytrauma, especially associated intraperitoneal injuries, adds to the complexity and complicates decisions related to the optimal care for these patients in hemorrhagic shock. The indications, timing, location, and technique for angioembolization differ based on available resources and expertise. Regional, institutional, and personal preferences add further variation to practice patterns and outcomes. While complications are associated with pelvic angioembolization, the actual causal relationship is questionable. Furthermore, angioembolization is frequently a life-saving maneuver without an effective alternative treatment. The wealth of recent literature will be pieced together to define the role that angioembolization should play in the management of pelvic fracture-related hemorrhage.

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Early embolization without external fixation in pelvic trauma

Cited by 29 publications

References 17 publications

Outcomes and complications of angioembolization for hepatic trauma

Outcomes and complications of angioembolization for hepatic trauma

Mortality in trauma patients with active arterial bleeding managed by embolization or surgical packing: An observational cohort study of 66 patients

Angioembolization: Indications, Approach and Optimal Use

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