IR Playbook pp 371-377 | Cite as

Pelvic and Extremity Trauma

  • Howard M. RichardEmail author


Pelvic and extremity trauma is the result of penetrating or blunt trauma alone or in combination which may result in hemorrhage or ischemia. Both scenarios can result in limb loss and potentially fatal outcomes. Initial resuscitative management of these patients is based on control of bleeding and restoration of flow to the distal extremity. Traditionally, this has been managed by surgical exploration. More recently, endovascular techniques have advanced to the point where these patients can be managed percutaneously. In the case of bleeding, transcatheter embolization is a safe and effective method for the control of ongoing hemorrhage in pelvic and extremity trauma. In the case of ischemia, injuries such as arterial dissections can be managed with percutaneous stent repair to restore flow to the distal aspect of the extremity.


Trauma Angiography Embolization 


  1. 1.
    Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, et al. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture–update and systematic review. J Trauma. 2011;71(6):1850–68.PubMedGoogle Scholar
  3. 3.
    Alton TB, Gee AO. Classifications in brief: young and burgess classification of pelvic ring injuries. Clin Orthop Relat Res. 2014;472(8):2338–42.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Alton TB, Gee AO. Classifications in brief: letournel classification for acetabular fractures. Clin Orthop Relat Res. 2014;472(1):35–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Halawi MJ. Pelvic ring injuries: emergency assessment and management. J Clin Orthop Trauma. 2015;6(4):252–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hussami M, Grabherr S, Meuli RA, Schmidt S. Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures. Int J Legal Med. 2017;131(3):731–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Karadimas EJ, Nicolson T, Kakagia DD, Matthews SJ, Richards PJ, Giannoudis PV. Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature. Int Orthop. 2011;35(9):1381–90.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ben-Menachem Y, Coldwell DM, Young JW, Burgess AR. Hemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management. AJR Am J Roentgenol. 1991;157(5):1005–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Kimbrell BJ, Velmahos GC, Chan LS, Demetriades D. Angiographic embolization for pelvic fractures in older patients. Arch Surg. 2004;139(7):728–32; discussion 32–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Kim PH, Leopold SS. In brief: Gustilo-Anderson classification. [Corrected]. Clin Orthop Relat Res. 2012;470(11):3270–4.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Fox N, Rajani RR, Bokhari F, Chiu WC, Kerwin A, Seamon MJ, et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S315–20.CrossRefPubMedGoogle Scholar
  12. 12.
    Juern JS, Milia D, Codner P, Beckman M, Somberg L, Webb T, et al. Clinical significance of computed tomography contrast extravasation in blunt trauma patients with a pelvic fracture. J Trauma Acute Care Surg. 2017;82(1):138–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, et al. Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: a content analysis and expert appropriateness rating study. J Trauma Acute Care Surg. 2015;79(4):568–79.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Walker ML. The damage control laparotomy. J Natl Med Assoc. 1995;87(2):119–22.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Kerr WS Jr, Margolies MN, Ring EJ, Waltman AC, Baum SN. Arteriography in pelvic fractures with massive hemorrhage. Trans Am Assoc Genitourin Surg. 1972;64:14–7.PubMedGoogle Scholar
  16. 16.
    Margolies MN, Ring EJ, Waltman AC, Kerr WS Jr, Baum S. Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med. 1972;287(7):317–21.CrossRefPubMedGoogle Scholar
  17. 17.
    Ayella RJ, RW DP Jr, Khaneja SC, Maekawa K, Soderstrom CA, Rodriguez A, et al. Transcatheter embolization of autologous clot in the management of bleeding associated with fractures of the pelvis. Surg Gynecol Obstet. 1978;147(6):849–52.PubMedGoogle Scholar
  18. 18.
    Scemama U, Dabadie A, Varoquaux A, Soussan J, Gaudon C, Louis G, et al. Pelvic trauma and vascular emergencies. Diagn Interv Imaging. 2015;96(7–8):717–29.CrossRefPubMedGoogle Scholar
  19. 19.
    Kufner S, Cassese S, Groha P, Byrne RA, Schunkert H, Kastrati A, et al. Covered stents for endovascular repair of iatrogenic injuries of iliac and femoral arteries. Cardiovasc Revasc Med. 2015;16(3):156–62.CrossRefPubMedGoogle Scholar
  20. 20.
    Abrassart S, Stern R, Peter R. Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 2013;99(2):175–82.CrossRefPubMedGoogle Scholar
  21. 21.
    Marzi I, Lustenberger T. Management of bleeding pelvic fractures. Scand J Surg. 2014;103(2):104–11.CrossRefPubMedGoogle Scholar
  22. 22.
    Ierardi AM, Duka E, Lucchina N, Floridi C, De Martino A, Donat D, et al. The role of interventional radiology in abdominopelvic trauma. Br J Radiol. 2016;89(1061):20150866.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Shi J, Gomes A, Lee E, Kee S, Moriarty J, Cryer H, et al. Complications after transcatheter arterial embolization for pelvic trauma: relationship to level and laterality of embolization. Eur J Orthop Surg Traumatol. 2016;26(8):877–83.CrossRefPubMedGoogle Scholar
  24. 24.
    DuBose JJ, Savage SA, Fabian TC, Menaker J, Scalea T, Holcomb JB, et al. The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry: multicenter data on modern vascular injury diagnosis, management, and outcomes. J Trauma Acute Care Surg. 2015;78(2):215–22; discussion 22–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Interventional Radiology, Department of Diagnostic Radiology and Nuclear MedicineUniversity of Maryland School of Medicine, University of Maryland Medical CenterBaltimoreUSA

Personalised recommendations