[Percutaneous management of hemorrhages in pelvic fractures].
OBJECTIVE
To report our experience in the control of haemorrhage with the transcatheter embolisation technique.


METHODS
Between 1999-2001, we treated 56 patients with important pelvic trauma. Forty-two were victims of car accidents and 14 of falls from great altitudes. Twenty presented acute symptoms due to blunt pelvic trauma, with massive bleeding, not treatable by drugs and blood transfusion. Diagnosis of pelvic haemorrhage was made with CT. When high-flow haemorrhage was found, the patient was referred for angiography. Embolisation was achieved after a diagnostic arteriography, with bilateral transfemoral approach and selective catheterisation of the internal iliac arteries.


RESULTS
Technical success was achieved in 100% of cases: all the haemorragic sites were found and embolised. In only one patient with severe shock was it impossible to locate the site of contrast material extravasation on the first day; the patient was successfully treated on the second day with improvement of the clinical conditions. The obturator artery was involved in five cases, the gluteal artery in eleven. In eighteen patients, use of an angiographic catheter was sufficient to treat the haemorragic sites. Percutaneous control of the haemorrhage was obtained by using Gelfoam, Ivalon and coils.


CONCLUSIONS
Percutaneous haemorrhage control is safe and effective, and not as costly or dangerous as the surgical option. We regard it as the treatment of choice in multiple trauma patients with important and high-flow pelvic haemorrhage.
Pieri
Stefano
S
Struttura di Radiologia Vascolare ed Interventistica, Azienda Ospedaliera S. Camillo-Forlanini, Roma. stepieri@excite.it
Agresti
Paolo
P
Morucci
Maurizio
M
De' Medici
Lorenzo
L
Galluzzo
Michele
M
Oransky
Michel
M
D000293:Adolescent; D000328:Adult; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D015641:Radiography, Interventional; D016896:Treatment Outcome