Transcatheter Embolization in Pelvic Trauma

Abstract

This article outlines the clinical and radiological approach to patients with pelvic trauma. It reviews the clinical descriptions and classifications of pelvic trauma as well as the management of patients with stable and unstable fractures. A review of embolization techniques in these types of patients is provided.

“Beyond saving lives”: Current perspectives of interventional radiology in trauma

“…However, optimal therapeutic approach remains controversial which largely depends on the expertise and availability of subspecialty physicians and support staff[6,36,37,39,40]. …”

“…Furthermore, arterial bleeding is usually due to multiple small peripheral branches which may be difficult to access or identify during surgery. Even, bilateral internal iliac ligation may prove futile in these cases due to the rich collateral circulation in pelvis[ 6 , 39 , 40 ].…”

“…Accordingly, catheter angiography is usually not performed if CT angiography does not reveal any findings suggestive of vascular injury. Embolization may also be a temporary adjunct before the definitive surgery[ 6 , 36 , 37 , 39 , 40 ].…”

The Corona Mortis, a Frequent Vascular Variant Susceptible to Blunt Pelvic Trauma: Identification at Routine Multidetector CT

“…Unfortunately, the raw data from the CT study had been deleted at the time of the initiation of this study, thus preventing subsequent postprocessing to create thinner sections. For the interventionalist, it has been suggested to routinely perform external iliac angiography when hemorrhage in the obturator region is detected at preprocedure CT (3,27). As demonstrated in this study, a small percentage of patients have co-dominant obturator arteries originating from both the internal and external iliac arterial systems, and "back door" bleeding may occur if the corona mortis is not properly identified and embolized.…”

“…Pelvic fractures and their associated bleeding are usually diagnosed with contrast-enhanced multidetector computed tomography (CT), which is readily available in most emergency departments today (1,2). If such trauma leads to hemodynamic instability, interventional radiology has the unique capacity to rapidly and effectively confirm and then embolize hemorrhaging sites, with less morbidity and greater efficacy than traditional operative treatment (2)(3)(4).…”