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The role of endovascular treatment of pelvic fracture bleeding in emergency settings

  • Emergency Radiology
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Abstract

Purpose

To evaluate the role of endovascular treatment for controlling haemorrhage in haemodynamically unstable patients with pelvic bone fractures and to relate clinical efficacy to pre-procedural variables.

Materials and Methods

From March 2009 through April 2013, 168 patients with major pelvic trauma associated with high-flow haemorrhage were referred to our emergency department and were retrospectively reviewed. Pelvic arteries involved were one or more per patient. Embolisation was performed using various materials (micro-coils, Spongostan, plug, glue, covered stent), and technical success, complications, treatment success, clinical efficacy, rebleeding, and mortality rates were assessed. Factors influencing clinical efficacy were also evaluated.

Results

The technical success rate was 100 %; no complications occurred during the procedures. Treatment was successful in 94.6 % cases, and clinical efficacy was 85.7 %. Three patients had to undergo a second arteriography due to recurrent haemorrhage. Fifteen patients died. Pre-embolisation transfusion demand was significantly associated with clinical efficacy.

Conclusions

Percutaneous embolisation of pelvic bleeding may be considered a safe, effective, and minimally invasive therapeutic option. As haemodynamic stability is the first objective with traumatic haemorrhagic patient, arterial embolisation can assume a primary role. On the basis of our results, pre-procedural transfusion status may be considered a prognostic factor.

Key Points

• The series presented is one of the largest in a single centre.

• Arterial embolisation is a life-saving procedure in patients with pelvic haemorrhage.

• In pelvic traumas associated with haemorrhage, prognosis is dependent upon prompt treatment.

• Transfusion status is significantly related to clinical efficacy.

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Acknowledgements

The scientific guarantor of this publication is Gianpaolo Carrafiello. 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. The authors state that this work has not received any funding. Statistical methods were necessary for this paper. Internal institutional review board approval was obtained. Written informed consent was obtained when possible. No study subjects or cohorts have been previously reported (in previous publications). Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Interventional Radiology Unit, Department of Radiology, University of Insubria, Viale Borri 57, 2110, Varese, Italy

    Anna Maria Ierardi, Filippo Piacentino, Federico Fontana, Chiara Floridi & Gianpaolo Carrafiello

  2. Department of Radiology, Second University of Naples, Naples, Italy

    Mario Petrillo

  3. Anaesthesia and Palliative Care, University of Insubria, Varese, Italy

    Alessandro Bacuzzi & Salvatore Cuffari

  4. Interventonal Cardiology, Al Qassimi Hospital, Sharjah, United Arab Emirates

    Wael Elabbassi

  5. Department of Biotechnology and Life Sciences, Medical Physics University Hospital, Varese, Italy

    Raffaele Novario

Authors
  1. Anna Maria Ierardi
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  2. Filippo Piacentino
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  3. Federico Fontana
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  4. Mario Petrillo
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  5. Chiara Floridi
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  7. Salvatore Cuffari
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  8. Wael Elabbassi
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  9. Raffaele Novario
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  10. Gianpaolo Carrafiello
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Correspondence to Gianpaolo Carrafiello.

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Ierardi, A.M., Piacentino, F., Fontana, F. et al. The role of endovascular treatment of pelvic fracture bleeding in emergency settings. Eur Radiol 25, 1854–1864 (2015). https://doi.org/10.1007/s00330-015-3589-3

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  • DOI: https://doi.org/10.1007/s00330-015-3589-3

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