Outcome of angiographic embolisation for unstable pelvic ring injuries: Factors predicting success

El-Haj, Madi; Bloom, Allan I.; Mosheiff, Rami; Liebergall, Meir; Weil, Yoram A.

doi:10.1016/j.injury.2013.05.017

Cited by 44 publications

(49 citation statements)

References 31 publications

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“…22 Bleeding usually originates from cancellous bone, presacral venous plexus, and/or iliac vessels. 23,24 Extra-pelvic hemorrhage can also occur due to the often high-energy trauma required to disrupt the pelvis, with long bones and abdominal viscera being the most common sites. 25 The incidence of associated long bone fractures in unstable pelvic ring injuries has been reported to be over 80%.…”

Section: Hemodynamic Instabilitymentioning

confidence: 99%

“…Arterial hemorrhage has been reported to occur in up to 15% of hemodynamically unstable pelvic ring injuries. 23 It usually presents with hypotension refractory to resuscitation and mechanical stabilization. 38 Arterial injury carries poor prognosis, especially when larger arteries are involved.…”

Section: Angiographic Embolizationmentioning

confidence: 99%

“…24 There is currently no clear association between fracture pattern and vascular injury or need for angiographic embolization. 39 Indications for angiography are hemodynamic instability refractory to resuscitation, partially responsive patients with contrast extravasation on CT scan, and progressive decline in hemoglobin level requiring ≥ 4 units of blood within 8 h. 23 El-Haj et al retrospectively reviewed 61 patients who underwent angiography for hemodynamic instability, 38 of whom (62%) required embolization. 23 Among those patients, 27 (71%) had embolization of a single vessel and 11 (29%) required embolization of multiple vessels.…”

Section: Angiographic Embolizationmentioning

confidence: 99%

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Pelvic ring injuries: Emergency assessment and management

Halawi

2015

Journal of Clinical Orthopaedics and Trauma

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Pelvic ring injuries are associated with significant morbidity and mortality. Understanding the anatomy of the pelvic ring is essential for accurate diagnosis and treatment. A systematic approach taking into account the mechanism of injury, physical examination, and radiographic assessment is important to quickly identify unstable pelvic disruptions and associated injuries. Because the pelvis is a ring structure, isolated pubic rami fractures on plain radiographs are unusual and should warrant careful evaluation for posterior pelvic disruption with computed tomography. Hemorrhagic shock can occur in about 10% of pelvic ring injuries. Immediate recognition and treatment of this life-threatening condition is critical in emergency management. In addition to fluid resuscitation and blood transfusion, circumferential wrapping, angiographic embolization, laparotomy with pelvic packing, and external fixation can be important life-saving adjuncts in the setting of hemodynamic instability.

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Section: Hemodynamic Instabilitymentioning

confidence: 99%

Section: Angiographic Embolizationmentioning

confidence: 99%

Section: Angiographic Embolizationmentioning

confidence: 99%

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Pelvic ring injuries: Emergency assessment and management

Halawi

2015

Journal of Clinical Orthopaedics and Trauma

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“…In the subgroup analysis, hospital mortality among the pediatric pelvic fracture patients with shock on hospital arrival was lower in the PA group than in the non-PA group. In adult patients with pelvic fractures, some studies pointed out that various factors such as hemodynamic instability need to be considered before performing emergency angiography [28][29][30][31][32]. Therefore, among patients with shock on hospital arrival, the identification of arterial bleeding by proactive PA would lead to the simultaneous implementation of TAE and, subsequently, a better outcome.…”

Section: Discussionmentioning

confidence: 99%

Pelvic angiography is effective for emergency pediatric patients with pelvic fractures: a propensity-score-matching study with a nationwide trauma registry in Japan

Katayama

Kitamura

Hirose

et al. 2019

Eur J Trauma Emerg Surg

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Purpose The aim of this study was to evaluate the association between the implementation of pelvic angiography (PA) and outcome in emergency pediatric patients with pelvic fracture. Methods We extracted data on pelvic fracture patients aged ≤ 19 years between 2004 and 2015 from a nationwide trauma registry in Japan. The main outcome was hospital mortality. We assessed the relationship between implementation of PA and hospital mortality using one-to-one propensity-score-matching analysis to reduce potential confounding effects in comparing the PA group with the non-PA group. Results In total, 1351 patients were eligible for our analysis, with 221 patients (16.4%) included in the PA group and 1130 patients (83.6%) included in the non-PA group. For all patients, the proportion of hospital mortality was higher in the PA group than in the non-PA group [13.6% (30/221) vs 7.1% (80/1130), crude odds ratio (OR) 2.062 (95% confidence interval (CI), 1.318-3.224); p = 0.002]. In the propensity-score-matched patients, the proportion of hospital mortality was lower in the PA group than in the non-PA group [10.5% (22/200) vs 18.2% (38/200), p = 0.027]. This finding was confirmed in both the multivariable logistic regression model [adjusted OR 0.392 (95% CI, 0.171-0.896); p = 0.026] and the conditional logistic regression model [conditional OR 0.484 (95% CI, 0.261-0.896); p = 0.021]. Conclusion The implementation of PA was significantly associated with lower hospital mortality among emergency pediatric patients with pelvic fractures compared with the non-implementation of PA.

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“…Following preclinical stabilization by means of a pelvic belt, compression of unstable pelvic fractures is achieved with an external fixator (Figure 3) or a pelvic clamp. Radiological intervention and vascular embolization have become important in the management of persistent bleeding (25). Definitive surgical management of pelvic girdle fractures ensues according to DCS principles following stabilization of the patient.…”

Section: Nonsurgical Management Early Total Care and Damage Controlmentioning

confidence: 99%