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Pelvic Trauma: factors predicting arterial hemorrhage and the role of Angiography and preperitoneal pelvic packing

European Radiology volume 30, pages 6376–6383 (2020)Cite this article

Abstract

Objectives

(1) To identify the factors predicting arterial extravasation in pelvic trauma and (2) to assess the efficacy of preperitoneal pelvic packing (PPP) in controlling arterial hemorrhage.

Methods

Institutional review board approved the retrospective study of 139 consecutive pelvic trauma patients who underwent angiographic intervention with or without prior PPP between January 2011 and December 2016. Patient demographics and presenting characteristics were recorded. Both groups of patients were combined for analysis of predictors for arterial extravasation using univariate logistic regression followed by multivariate logistic regression. Significance level was defined as p < 0.05.

Results

Forty-nine out of 139 patients had PPP prior to pelvic angiogram. Embolization was performed in 85 (61.2%) patients and the technical and clinical success rate was 100%. Sixty-nine (49.7%) patients had unstable Young-Burgess (Y&B) type fractures, of which 58% had arterial hemorrhage compared with 38.6% of those with stable Y&B fractures (p = 0.02). Of the patients who had PPP prior to angiogram, 28(57.1%) continued to have arterial extravasation on subsequent angiography. Unstable Y&B type fractures are independent predictors of arterial hemorrhage (OR 2.3, 95%CI 1.1 to 4.7, p = 0.02).

Conclusion

Unstable Y&B type pelvic fractures are predictors of arterial extravasation. PPP alone is not effective for arterial hemorrhage control in pelvic trauma. Angiographic intervention remains a minimally invasive and definitive treatment of arterial hemorrhage from pelvic trauma.

Key Points

• Unstable Young-Burgess pelvic fractures are predictors of arterial hemorrhage in pelvic trauma.

• Pelvic angiography and embolization should precede PPP wherever feasible.

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Abbreviations

APC:

Anterioposterior compression

CM:

Combined mechanism

LC:

Lateral compression

PPP:

Preperitoneal pelvic packing

REBOA:

Resuscitative endovascular balloon occlusion of the aorta

VS:

Vertical shear

Y&B:

Young and Burgess

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Funding

The authors state that this work has not received any funding.

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Affiliations

  1. University of Miami Miller School of Medicine, Miami, FL, USA

    Jagteshwar Sandhu

  2. University of Miami Hospitals and Clinics, 1475 NW 12th Ave. Suite 1066-V, Miami, FL, 33136, USA

    Jagteshwar Sandhu

  3. Diagnostic and Interventional Radiology, Haywood Medical Imaging, Clyde, NC, USA

    Robert Abrahams

  4. Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA

    Zoe Miller, Shivank Bhatia & Prasoon Mohan

  5. Department of Surgery, Jackson Memorial Hospital, Miami, FL, USA

    Tanya L Zakrison

Authors
  1. Jagteshwar Sandhu
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  2. Robert Abrahams
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  3. Zoe Miller
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  4. Shivank Bhatia
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  5. Tanya L Zakrison
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  6. Prasoon Mohan
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Corresponding author

Correspondence to Jagteshwar Sandhu.

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Guarantor

The scientific guarantor of this publication is Dr. Prasoon Mohan

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Sandhu, J., Abrahams, R., Miller, Z. et al. Pelvic Trauma: factors predicting arterial hemorrhage and the role of Angiography and preperitoneal pelvic packing. Eur Radiol 30, 6376–6383 (2020). https://doi.org/10.1007/s00330-020-06965-9

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  • DOI: https://doi.org/10.1007/s00330-020-06965-9

Keywords

  • Trauma
  • Angiography
  • Pelvis
  • Hemorrhage
  • Fracture