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Transcatheter embolization for massive posttraumatic pelvic hemorrhage

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Abstract

The purpose of this study was a retrospective review of patients treated by transcatheter embolization for management of life-treatening pelvic hemorrhage due to trauma. Sixty-one patients with suspected significant pelvic hemorrhage from trauma were referred for arteriography and consideration of embolization. The etiology was blunt trauma in 56 patients (92%) and gunshot wound in 5 patients (8%). Embolization followed selective arteriography in 37 patients (61%). Embolization was performed using coils, coils and Gelfoam, or coils and polyvinyl alcohol sponge particles in all cases.

Of the 37 patients embolized, causative arteriographic lesions were identified in 32 patients (86%). In 5 patients, only minor vascular abnormalities were identified, but coupled with clinical findings, empiric treatment was warranted. Thirty-four of 37 patients (92%) stabilized hemodynamically after embolization. Two of the 34 had recurrent hemorrhage, which was permanently arrested by re-embolization. In 3 of 37 patients (8%), exsanguination occurred before embolization was completed. All had significant delays in recognition of pelvic hemorrhage as the source of hemodynamic instability.

Transcatheter embolization is safe and effective in our experience. We attribute the three deaths to delay in recognition of pelvic hemorrhage as the cause of hemodynamic instability, not failure of embolization.

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Authors and Affiliations

  1. Department of Radiology, Arizona Health Sciences, Center, 85724, Tucson, 1501 N. Campbell Avenue, Arizona

    Stephen H. Smyth M.D., Christopher J. Bosarge M.D., Donald J. Roach M.D., Mark S. Asay M.D. & Gerald D. Pond M.D.

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  1. Stephen H. Smyth M.D.
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  2. Christopher J. Bosarge M.D.
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  3. Donald J. Roach M.D.
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  4. Mark S. Asay M.D.
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  5. Gerald D. Pond M.D.
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Smyth, S.H., Bosarge, C.J., Roach, D.J. et al. Transcatheter embolization for massive posttraumatic pelvic hemorrhage. Emergency Radiology 4, 367–370 (1997). https://doi.org/10.1007/BF01451072

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