Update on the roles of angiography and embolisation in pelvic fracture

Frevert, Susanne; Dahl, Benny; Lönn, Lars

doi:10.1016/j.injury.2008.07.004

Cited by 60 publications

(31 citation statements)

References 17 publications

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“…The combined use of traditional surgery and intervention had been widely used in trauma patients in the 1990s, such as hepatic arterial embolization for severe liver injury and internal iliac artery embolization for pelvic fracture [5,6]. However, these techniques were often used for severe patients who cannot tolerate operation or patients with postoperative bleeding.…”

Section: Discussionmentioning

confidence: 99%

“One-Stop Hybrid Procedure” in the Treatment of Vascular Injury of Lower Extremity

et al. 2013

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As a new surgical technique, "one-stop hybrid procedure" is rarely applied in trauma patients. This paper aims to explore its role in vascular injury of the lower extremity. Vascular intervention combined with open surgery was performed to treat three cases of vessel injuries of the lower extremity in our hybrid operating room. One patient with stab injury to the left femoral vein was treated by temporary artery blocking after excluding arterial injury by angiography, followed by blocking surgery and debridement and repair of the injured vein. The other two patients with drug addiction history, who were found to have pricking injuries to the femoral artery combined with local infection, were successfully treated by endovascular techniques and open debridement. One-stop hybrid procedure in treating vascular injury patients could simplify the operation procedure, reduce operative risk, and achieve good curative effect.

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Section: Discussionmentioning

confidence: 99%

“One-Stop Hybrid Procedure” in the Treatment of Vascular Injury of Lower Extremity

et al. 2013

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“…Although TAE is one of the most useful modalities for con- ma, it may be associated with various complications, including puncture site hematoma, impotence, iliofemoral embolization, paraparesis, and ischemic necrosis of the bladder wall, gluteal skin, femoral head, gluteal muscle, and colon (6)(7)(8)(9)(10)(11)(12)(13). Super-selective catheterization of injured vessels may be a good option for avoiding complications related to TAE, because the blood flow to adjacent structures can be maintained by selectively embolizing only the injured vessel.…”

Section: Introductionmentioning

confidence: 99%

“…Super-selective catheterization of injured vessels may be a good option for avoiding complications related to TAE, because the blood flow to adjacent structures can be maintained by selectively embolizing only the injured vessel. However, super-selective catheterization of injured vessel is regarded as a time-consuming step and may therefore be unreasonable to perform in patients with unstable hemodynamics due to massive bleeding (6). In this retrospective study, we aimed to determine whether re-evaluation of TAE after super-selective catheterization is necessary for treatment of life-threatening pelvic hemorrhage after trauma.…”

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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“…The role of angiography [11,12] has been a topic of lively discussion lately. Should angiography be used as a primary intervention for control of bleeding?…”

Section: Introductionmentioning

confidence: 99%

Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

Karadimas

Nicolson

Kakagia

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the relation between pelvic fracture patterns and the angiographic findings, and to assess the effectiveness of the embolisation. Methods This retrospective study, included patients with pelvic fractures and angiographic evaluation. Demographics, Injury Severity Score (ISS), associated injuries, embolisation time, blood units needed, method of treatment and complications were recorded and analysed. Fractures were classified according to the Burgess system. Results Between 1998 and 2008, 34 patients with pelvic fractures underwent angiographic investigation. Twenty six were males. The mean age was 41 years. Twenty-seven were motor vehicle accidents and seven were falls. There were 11 anterior posterior (APC) fractures, 12 lateral compression (LC), eight vertical shear (VS) patterns and three with combined mechanical injuries. The median ISS was 33.1 (range 5-66). From the 34 who underwent angiography, 29 had positive vascular extravasations. From them, 21 had embolisation alone, two had vascular repair and embolisation, five required vascular repair alone and one patient died while being prepared for embolisation. Five cases were re-embolised. The findings suggested that AP fractures have a higher tendency to bleeding compared with LC fractures. Both had a higher chance of blood loss compared to VS and complex fracture patterns. We reported 57 additional injuries and 65 fractures. The complications were: one non lethal pulmonary embolism, one renal failure, one liver failure, one systemic infection, two deep infections and two psychological disorientations. Seven patients died in hospital. Conclusion Control of pelvic fracture bleeding is based on the multidisciplinary approach mainly related to hospital facilities and medical personnel's awareness. The morphology of the fracture did not have a predictive value of the vascular lesion and the respective bleeding.

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Update on the roles of angiography and embolisation in pelvic fracture

Cited by 60 publications

References 17 publications

“One-Stop Hybrid Procedure” in the Treatment of Vascular Injury of Lower Extremity

“One-Stop Hybrid Procedure” in the Treatment of Vascular Injury of Lower Extremity

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

Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

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