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Interventionelle Radiologie als Notfalltherapie bei Beckenverletzungen

Interventional radiology as emergency treatment for pelvic injuries

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Zusammenfassung

Klinisches Problem

Arterielle pelvine Blutungen stellen eine potenziell lebensbedrohliche Situation dar, die insbesondere im Fall ligamentärer Zerreißungen mit Erhöhung des Beckenvolumens mithilfe chirurgischer Verfahren allein nur schwierig zu kontrollieren sein können.

Radiologische Standardverfahren

Durch die Angiographie und Embolisation (AE) mithilfe resorbierbarer gelatinehaltiger Partikel oder permanenten Coils, Plugs, Flüssigembolisaten oder durch ein Gefäß-Stenting können traumatische arterielle Beckenblutungen in den meisten Fällen gestoppt sowie Pseudoaneurysmata, arteriovenöse Fistelungen oder Dissektionen ausgeschalten werden.

Methodische Innovation und Bewertung

Die AE hat sich als schnelles und effektives minimal-invasives Vorgehen bei der Behandlung traumatischer pelviner Gefäßverletzungen mit vorteilhaftem Nutzen-Risiko-Verhältnis in der Therapie etabliert.

Empfehlung für die Praxis

Die Indikation zur AE sollte interdisziplinär gestellt werden; diese kann sowohl als definitive Therapie als auch in Kombination mit chirurgischen Verfahren zum Einsatz kommen. Um das Outcome zu verbessern, sollten jegliche Verzögerungen zwischen Indikationsstellung und Start des Eingriffs verhindert werden.

Abstract

Clinical issue

Pelvic arterial bleeding constitutes a potentially life-threatening event, which can be difficult to control with surgical procedures alone, especially in the case of ligamentous ruptures and a subsequently increased pelvic volume.

Standard radiological procedures

Using angiography and embolization (AE) with resorbable gelatine-based particles or permanent coils, plugs, liquid embolic systems or by vascular stenting, in most cases traumatic pelvic arterial bleeding can be stopped and can also be used to close pseudoaneurysms, arteriovenous fistulas or dissections.

Methodological innovation and evaluation

The AE has become established as a fast and effective minimally invasive procedure in the treatment of traumatic pelvic vascular injuries with an advantageous risk-benefit ratio.

Practical recommendations

An interdisciplinary approach should be used in the indications for AE; which can be used as definitive treatment as well as in combination with surgical procedures. To improve the clinical outcome any delay between establishing the indications and the start of the intervention must be avoided.

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Correspondence to Marco Armbruster.

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Interessenkonflikt

M. Armbruster gibt an, dass kein Interessenkonflikt besteht. M. Seidensticker: „lecture fees“ (Fa. Cook Medical, Fa. Boston Scientific).

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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J. Lotz, Göttingen

M.-A. Weber, Rostock

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Armbruster, M., Seidensticker, M. Interventionelle Radiologie als Notfalltherapie bei Beckenverletzungen. Unfallchirurg 124, 627–634 (2021). https://doi.org/10.1007/s00113-021-01045-z

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Schlüsselwörter

  • Trauma
  • Blutung
  • Diagnostische Bildgebung
  • Therapeutische Embolisation
  • Angiographie

Keywords

  • Trauma
  • Bleeding
  • Diagnostic imaging
  • Therapeutic embolization
  • Angiography