Predictive parameters for angiography and embolization in the bleeding pelvic fracture

Abstract

a b s t r a c tAim: In the bleeding pelvic fracture, decision needs to be made on definitive control of bleeding whilst resuscitation. The decision for angiography in unstable patients is difficult and this study hopes to identify the parameters that may aid in this decision. patients who underwent angiographic evaluation were identified. 11 out of the 15 had angiography and embolization done, while the remaining 4 only had angiography done.Another group of 29 patients who had not undergone angiography were identified from the main population via age-matched criteria. Clinical parameters were compared between the 15 angiography patients and the 29 non-angiography group of patients.Results: Angiography group had a larger proportion (80%) with contrast blush noted on contrast-enhanced CT scan (CECT), a higher proportion with unstable pelvic fracture patterns as classified by Tile (80%), and Young and Burgess (92.4%) ( p < 0.05). Embolized group had higher proportion (81.8%) with hematoma and with blush on CECT (100%), and higher proportion with unstable fracture patterns (UFPs) (72.7%) as classified by Tile ( p < 0.05).Positive predictive value for embolization using hematoma alone is 39% while that of blush alone is 73% and unstable Tile fracture alone is 47%. Positive predictive value of combined hematoma, blush and unstable Tile fracture pattern is 75%.Conclusion: Significant predictive factors for angiogram would be unstable pelvic fracture patterns, presence of hematoma and contrast blushing on CT.

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

“…Lunsjo et al [ 11 ] observed an association of mortality with ISS but not with the pelvic fracture pattern. Anandakumar et al [ 12 ] observed a link between Tile fracture patterns and arterial contrast extravasation with need for AAE. Hussami et al [ 13 ] found a significant correlation between the Tile fracture type and arterial, but not venous bleeding in a series of trauma patients who underwent postmortem CT. Rommens and Hessmann [ 9 ] not only found a higher mortality rate, but also worse functional outcomes when comparing type C with type B fractures.…”

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

“…Anandakumar et al identified 11 patients over a 5-year period who underwent angio-embolisation and their selection criteria are more liberal than ours. 6 The retrospective nature of our series and the low patient numbers reflect limitations of our study.…”

“…17,18,19 Successful embolisation rates for arterial injuries have been reported to be 85-100%. 1 In our study the delay from admission to angio-embolisation was considerably longer with a mean of 14 hours (range 4-24).…”

“…Anandakumar et al overcome this by performing angiography in the operating theatre with an anaesthetist present in case the patient deteriorates and requires a laparotomy. 6 Complications related to angiography and embolisation include ulceration at the entry point, skin necrosis, perineal or buttock paraparesis and thigh claudication. 7 Extraperitoneal pelvic packing is more widely available and is technically easier, but it is associated with a higher risk of infection as well as associated access morbidity.…”

The size of pelvic hematoma can be a predictive factor for angioembolization in hemodynamically unstable pelvic trauma

“…Angiographic embolization is proven to be a safe and effective treatment method in patients with pelvic trauma [12]. For the treatment of arterial injury in pelvic fracture, aggressive angiographic embolization has a high success rate [1,[4][5][6][12][13][14]. Nevertheless, although many studies have reported on the indications for pelvic angiography, precise guidelines have yet to be established.…”