title: [Percutaneous management of hemorrhages in pelvic fractures].
abstract: 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.
authors.affiliation: Struttura di Radiologia Vascolare ed Interventistica, Azienda Ospedaliera S. Camillo-Forlanini, Roma. stepieri@excite.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Pieri
authors.forename: Paolo
authors.initials: P
authors.lastname: Agresti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Morucci
authors.forename: Lorenzo
authors.initials: L
authors.lastname: De' Medici
authors.forename: Michele
authors.initials: M
authors.lastname: Galluzzo
authors.forename: Michel
authors.initials: M
authors.lastname: Oransky
mesh_terms: 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