Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature
- 371 Downloads
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.
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.
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.
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.
KeywordsInjury Severity Score Pelvic Fracture Vertical Shear Anterior Posterior Pelvic Ring
Conflict of interest
The authors declare that they have no conflict of interest.
- 6.Dickinson K, Roberts I (2000) Medical anti-shock trousers (pneumatic anti-shock garments) for circulatory support in patients with trauma. Cochrane Database Syst Rev 2:CD001856Google Scholar
- 37.Matalon TS, Athanasoulis CA, Margolies MN, Waltman AC, Novelline RA, Greenfield AJ, Miller SE (1979) Hemorrhage with pelvic fractures: efficacy of transcatheter embolization. Am J Roentgenol 133:859–864Google Scholar
- 41.Cryer HM, Miller FB, Evers BM, Rouben LR, Seligson DL (1988) Pelvic fracture classification: correlation with hemorrhage. J Trauma 28:974–980Google Scholar
- 48.Patel NH, Matsuo RT, Routt ML Jr (1996) An acetabular fracture with superior gluteal artery disruption. Am J Roentgenol 166:1074–1079Google Scholar