title: Angioembolization provides benefits in patients with concomitant unstable pelvic fracture and unstable hemodynamics.
abstract: BACKGROUND
  Pelvic fractures result in hemodynamic instability in 5% to 20% of patients, and the reported mortality rate is 18% to 40%. Previous studies have reported the application of angioembolization in pelvic fracture patients with a systolic blood pressure (SBP) less than 90 mm Hg, a fluid resuscitation requirement of more than 2000 mL, or a blood transfusion of more than 4 to 6 units within 24 hours. In the current study, we attempted to delineate the efficacy and outcome of angioembolization in unstable pelvic fracture patients with concomitant unstable hypotension status.
  
  
  METHODS
  We retrospectively reviewed the charts of patients with pelvic fractures between January 2005 and May 2010. We focused on unstable pelvic fracture patients with an SBP less than 90 mm Hg after fluid resuscitation who did not receive computed tomography scans. The demographics, injury severity score, abbreviated injury scale, and hemodynamic status after angioembolization were analyzed.
  
  
  RESULTS
  In total, 26 patients were enrolled. There were 16 patients receiving angioembolization directly without computed tomography scans and 12 patients receiving emergency laparotomy due to a finding of hemoperitoneum on sonography, followed by angioembolization. In both groups, the SBP improved significantly after angioembolization. The overall survival rate was 85.7%.
  
  
  CONCLUSIONS
  In patients with concomitant unstable hemodynamics and unstable pelvic fracture, angioembolization serves as an effective adjunct to hemostasis. Aggressive embolization should be performed even in patients without contrast extravasation in angiography.
authors.affiliation: Trauma and Emergency Center, China Medical University Hospital, Taichung 404, Taiwan, ROC. drfu5564@yahoo.com.tw
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.forename: Shih-Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
authors.forename: Chi-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Huang
authors.forename: Jui-Chien
authors.initials: JC
authors.lastname: Huang
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Lu
authors.forename: Yi-Chieh
authors.initials: YC
authors.lastname: Huang
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D004621:Embolization, Therapeutic; D005260:Female; D050723:Fractures, Bone / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D016896:Treatment Outcome