title: The role of endovascular treatment of pelvic fracture bleeding in emergency settings.
abstract: OBJECTIVE
  To evaluate the role of endovascular treatment for controlling haemorrhage in haemodynamically unstable patients with pelvic bone fractures and to relate clinical efficacy to pre-procedural variables.
  
  
  METHODS
  From March 2009 through April 2013, 168 patients with major pelvic trauma associated with high-flow haemorrhage were referred to our emergency department and were retrospectively reviewed. Pelvic arteries involved were one or more per patient. Embolisation was performed using various materials (micro-coils, Spongostan, plug, glue, covered stent), and technical success, complications, treatment success, clinical efficacy, rebleeding, and mortality rates were assessed. Factors influencing clinical efficacy were also evaluated.
  
  
  RESULTS
  The technical success rate was 100%; no complications occurred during the procedures. Treatment was successful in 94.6% cases, and clinical efficacy was 85.7%. Three patients had to undergo a second arteriography due to recurrent haemorrhage. Fifteen patients died. Pre-embolisation transfusion demand was significantly associated with clinical efficacy.
  
  
  CONCLUSIONS
  Percutaneous embolisation of pelvic bleeding may be considered a safe, effective, and minimally invasive therapeutic option. As haemodynamic stability is the first objective with traumatic haemorrhagic patient, arterial embolisation can assume a primary role. On the basis of our results, pre-procedural transfusion status may be considered a prognostic factor.
  
  
  CONCLUSIONS
  • The series presented is one of the largest in a single centre. • Arterial embolisation is a life-saving procedure in patients with pelvic haemorrhage. • In pelvic traumas associated with haemorrhage, prognosis is dependent upon prompt treatment. • Transfusion status is significantly related to clinical efficacy.
authors: Interventional Radiology Unit, Department of Radiology, University of Insubria, Viale Borri 57, 2110, Varese, Italy.
authors: Anna Maria
authors: AM
authors: Ierardi
authors: Filippo
authors: F
authors: Piacentino
authors: Federico
authors: F
authors: Fontana
authors: Mario
authors: M
authors: Petrillo
authors: Chiara
authors: C
authors: Floridi
authors: Alessandro
authors: A
authors: Bacuzzi
authors: Salvatore
authors: S
authors: Cuffari
authors: Wael
authors: W
authors: Elabbassi
authors: Raffaele
authors: R
authors: Novario
authors: Gianpaolo
authors: G
authors: Carrafiello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D010388:Pelvis / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
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