A protocol for angiographic embolization in exsanguinating pelvic trauma: a report on 31 patients.
BACKGROUND
The indication for acquiring angiographic embolization in the initial treatment of severe pelvic fractures is controversial. We describe the characteristics and outcome of 31 patients with traumatic pelvic bleeding who underwent percutaneous angiography with embolization according to a standardized protocol.


METHODS
During an 8.5-year period, 1,260 patients were treated for pelvic trauma. We performed a prospective registration of the 46 patients who underwent angiography, and report the 31 patients who had signs of significant arterial injury on angiography, necessitating embolization.


RESULTS
The rate of significant arterial injury after pelvic trauma was 2.5%. All patients had been subjected to high-energy injuries and all were severely injured as measured by the Injury Severity Score: 41 (17-66). Pelvic arterial injury was observed with all types of pelvic trauma, including isolated acetabular (4/31) and sacral fractures (3/31). The internal iliac artery or its branches was injured in 28 of 31 patients. Survival rate after embolization was 84%, and correlated inversely with increasing patient age. None of the patients died of bleeding.


CONCLUSIONS
Our findings show that significant pelvic arterial injuries occur in a minority of patients after pelvic trauma, and predominantly affect patients with multiple high-energy injuries regardless of fracture type. The effect of angiographic embolization was good.
Tötterman
Anna
A
Orthopaedic Centre, Ullevål University Hospital, Oslo, Norway. anna.totterman@ulleval.no
Dormagen
Johann Baptist
JB
Madsen
Jan Erik
JE
Kløw
Nils-Einar
NE
Skaga
Nils Oddvar
NO
Røise
Olav
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001158:Arteries / Q000293:injuries; D002985:Clinical Protocols; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D011446:Prospective Studies