title: Acute complications of patients with pelvic fractures after pelvic angiographic embolization.
abstract: BACKGROUND
  Hemodynamically unstable patients with a pelvic fracture and arterial pelvic bleeding frequently are treated with pelvic angiographic embolization (PAE). PAE is reported to be a safe and effective method of controlling hemorrhage. However, the loss of blood supply and subsequent ischemia from embolization may lead to adverse consequences.
  
  
  OBJECTIVE
  We sought to determine (1) the frequency and types of complications observed after PAE; (2) the mortality after PAE; and (3) the clinical factors associated with complications and mortality after PAE.
  
  
  METHODS
  We conducted a retrospective case series descriptive study at a Level I trauma center. Using our institution's trauma registry, we isolated patients with pelvic fractures treated with PAE admitted between June 1999 and December 2007. Complications attributed to PAE occurring in the initial hospital stay were recorded. We identified 98 patients with pelvic fractures treated by PAE with an average hospital stay of 25.3 days.
  
  
  RESULTS
  The complication rate was 11% and included six patients with gluteal muscle necrosis (6%), five with surgical wound breakdown (5%), four deep infections (4%), one superficial infection, two patients with of impotence (2%), and one with bladder necrosis. The mortality rate in the PAE group reached 20%. Bilateral embolization was performed in 100% of the patients with complications. Nonselective embolization was performed in 81% of patients with complications. All of the patients with gluteal necrosis had bilateral nonselective embolization.
  
  
  CONCLUSIONS
  Bilateral or nonselective PAE is associated with significant complications during the initial hospital stay. The value of PAE should be weighed against its possible adverse consequences. Selective unilateral arterial embolization should be considered whenever possible.
authors.affiliation: UCSF/SFGH Orthopaedic Trauma Institute, 2550 23rd Street, San Francisco, CA 94110, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Matityahu
authors.forename: Meir
authors.initials: M
authors.lastname: Marmor
authors.forename: Joshua Knute
authors.initials: JK
authors.lastname: Elson
authors.forename: Corey
authors.initials: C
authors.lastname: Lieber
authors.forename: Gregory
authors.initials: G
authors.lastname: Rogalski
authors.forename: Cindy
authors.initials: C
authors.lastname: Lin
authors.forename: Tigist
authors.initials: T
authors.lastname: Belaye
authors.forename: Theodore
authors.initials: T
authors.lastname: Miclau
authors.forename: Utku
authors.initials: U
authors.lastname: Kandemir
mesh_terms: D000368:Aged; D000792:Angiography / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006470:Hemorrhage / Q000150:complications / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D007511:Ischemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D010388:Pelvis / Q000098:blood supply* / Q000000981:diagnostic imaging; D012189:Retrospective Studies