Pelvic packing or angiography: Competitive or complementary?

Suzuki, Takashi; Smith, Wade R.; Moore, Ernest E.

doi:10.1016/j.injury.2008.12.006

Cited by 136 publications

(139 citation statements)

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“…This patient did not survive after embolization due to complications from a combined hypoxic brain injury. toneal hemorrhage resulting from pelvic fracture is difficult to control, and mortality remains high (2,3,9).…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…Currently, despite ongoing debates, TAE for bleeding pelvic trauma in hemodynamically unstable patients is regarded as a fundamental treatment option with open surgery, like pelvic packing (1)(2)(3)(4). Notably, according to the Eastern Association for Surgery's pelvic trauma guideline, emergent pelvic angiography and embolization in patients with unstable hemodynamic status has the highest level of recommendation (5).…”

Section: Introductionmentioning

confidence: 99%

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Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

Park

Yim

Kim

et al. 2016

J Korean Soc Radiol

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Purpose:To determine the efficacy of embolization with super-selective catheterization of the internal iliac arterial branches to treat heavily injured trauma patients with pelvic arterial bleeding. Materials and Methods: A retrospective analysis was performed using the medical records of 37 patients who underwent trans-arterial embolization for trauma-associated pelvic arterial hemorrhage in a regional trauma center between July 2010 and July 2013. In each patient, hemodynamic stability, embolization level, elapsed time for trans-arterial embolization, clinical outcome and embolization-related complications were evaluated. Comparison of elapsed time, and presence of complication was done according to embolization level. Results: Transarterial embolization was conducted in 37 patients. Hemodynamic stability of each patient was classified into hemodynamic stable (n = 9), and unstable (n = 28). Twenty-nine of 37 patients underwent embolization after super-selective catheterization of more than 2nd order branch of internal iliac artery with a microcatheter, and 8 patients underwent proximal internal iliac artery embolization without super-selective catheterization. The mean elapsed procedure time for super-selective embolization (34.76 ± 20.0 minutes) was not significantly longer than proximal internal iliac artery embolization (33.87 ± 16.73 minutes, p = 0.215). Conclusion: Pelvic arterial embolization with super-selective catheterization is a safe and feasible treatment for heavily injured patients with trauma-associated pelvic arterial bleeding.

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Section: Clinical Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

Park

Yim

Kim

et al. 2016

J Korean Soc Radiol

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“…The first preperitoneal packing was described by Hannover and Zurich groups which were done through transabdominal pelvic packing. 14,15 Direct preperitoneal packing was described in Denver, a surgical technique that was performed through suprapubic midline incision and allows direct retroperitoneal approach to the space of Rezius. 16 Single or multiple procedures can be considered on the management of the patient depending on patient stability after each procedure.…”

Section: Introductionmentioning

confidence: 99%

Management of hemodynamically unstable patients with fracture pelvis Mafraq Hospital experience, UAE

2017

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Background: Multidisciplinary team and multiple approaches were introduced to improve the outcome after significant pelvic trauma. In present study, we are evaluating our institutional management modalities for unstable patients with unstable pelvic fractures using angio-embolization, pelvic packing with or without angio-embolization and conservative management with surgical intensive care unit (SICU) admission.Methods: We reviewed 108 patients admitted with pelvic fractures from January 2013 to September 2014, 19 patients (17.5%) were hemodynamically unstable with pelvic fracture. Massive transfusion protocol was activated in all patients. FAST scan was done. Level 1 trauma CT for the responder and transient responder patients.Results: Out of 19 patients, 7 patients (36.8%) were good responders to resuscitation with maintaining of their hemoglobin stable, with no extravasation of dye, admitted to SICU for conservative management. 4 patients (21%) were responders with CT trauma revealed dye leak so they underwent angio-embolization, SICU admission. 8 patients (42.1%) were non-responders underwent preperitoneal packing, one of them had additional angio-embolization.Conclusions: Preperitoneal packing is an excellent choice for non-responder patients, while angio-embolization can be done for responder and transient responder patients with evident dye extravasation. This study needs more evaluation on a wider clinical scale.

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“…1,2 In patients who present in extremis the mortality rate is even higher. 3 The routine use of angiography and embolisation in the resuscitation of this patient group remains controversial.…”

Section: Introductionmentioning

confidence: 99%

“…5 Clear indications for angio-embolisation and patient selection criteria remain unclear, especially when compared to direct extraperitoneal pelvic packing. 1 Acceptable advantages of angio-embolisation are that it is selective as it is directed at the identified bleeding vessel and therefore has less access morbidity. Multiple active bleeders can also be targeted with this technique.…”

Section: Introductionmentioning

confidence: 99%

The role of interventional angiography and embolisation in the management of high-energy pelvic ring injuries with uncontrolled haemorrhage

et al. 2017

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Pelvic packing or angiography: Competitive or complementary?

Cited by 136 publications

References 100 publications

Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

Management of hemodynamically unstable patients with fracture pelvis Mafraq Hospital experience, UAE

The role of interventional angiography and embolisation in the management of high-energy pelvic ring injuries with uncontrolled haemorrhage

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