Repeat transcatheter arterial embolization for the management of pelvic arterial hemorrhage.
BACKGROUND
Most arterial hemorrhage associated with pelvic fracture can be adequately controlled by a single transcatheter arterial embolization (TAE). However, there is a small group of patients who remain hemodynamically unstable after TAE, have no other identifiable source of bleeding, and who benefit from repeat TAE of the pelvis.


METHODS
We conducted a retrospective study of patients with hemorrhage from pelvic fractures between January 2001 and June 2006. Clinical parameters and results were compared between patients requiring more than one pelvic TAE and those undergoing a single TAE. Risk factors for repeat TAE were identified by univariate and stepwise logistic regression analyses.


RESULTS
During the study period, 174 of 964 patients with pelvic fracture received pelvic angiography for suspected arterial hemorrhage. One hundred forty TAEs were performed. Thirty-four (24.3%) patients underwent more than one angiography for suspected recurrent arterial hemorrhage, and 26 (18.6%) underwent repeat TAE. Repeat angiography was performed 3 to 58 hours (mean, 21 hours) after initial TAE. Patients with repeat TAE had significantly more blood transfusions, higher mortality rate, and longer intensive care unit stay. Independent predictors for repeat TAE included initial hemoglobin level lower than 7.5 g/dL (OR, 6.22), superselective arterial embolization in initial TAE (OR, 3.22), and more than 6 units of blood transfusion after initial TAE (OR, 3.22).


CONCLUSIONS
Careful monitoring and prompt recognition of patients requiring repeat TAE is paramount. The arterial access sheath should remain in place for up to 72 hours after angiography. Initial hemoglobin level lower than 7.5 g/dL and more than 6 units of blood transfusion after initial angiography are predictors for repeat TAE. Superselective TAE is associated with a significantly higher risk of recurrent hemorrhage, and its use should be limited.
Fang
Jen-Feng
JF
Trauma and Critical Care Center, Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan. jimfang@adm.cgmh.org.tw
Shih
Lih-Yuann
LY
Wong
Yon-Cheong
YC
Lin
Being-Chuan
BC
Hsu
Yu-Pao
YP
D000328:Adult; D000465:Algorithms; D000792:Angiography; D001158:Arteries; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D012179:Retirement; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome