OTA 2002 Posters
Arterial Embolization to Control Pelvic Fracture Hemorrhage
Hans Gschnitzer, MD; Bahman Dolati, MD; Romed Sailer, MD; Michael Rieger, MD1; Peter Schandelmaier, MD; Michael Blauth, MD; 1University Klinik fur Radiologie, Universität Innsbruck, Innsbruck Medical School, Innsbruck, Austria
Purpose: Major pelvic trauma is occasionally followed by significant arterial hemorrhage. Certain patterns of pelvic ring disruption are more frequently accompanied by life-threatening arterial bleeding. In these cases, selective embolization is an option for acute therapy.
Methods: The records of 344 patients, treated at our hospital from 1995 to 2001 because of major blunt pelvic trauma, were studied retrospectively. At admission, 29 patients with a mean age of 40 years (range, 15 to 72) and a mean Injury Severity Score (ISS) of 37.92 ± 11.34, showed hemodynamically significant arterial bleeding from pelvic vessels. Bleeding was demonstrated by computed tomography as a localized extravazation and sedimentation of contrasting agents. Of these patients, 7 died during emergency management due to massive blood loss; 22 underwent angiography and selective embolization. We examined the type of pelvic injury, the source of arterial bleeding, and the hemodynamic situation during the acute phase. Classification of pelvic ring disruptions was done according to the Journal of Orthopaedic Trauma´Fracture and Dislocation Compendium. The need for blood products as an expression of overall hemodynamics was observed, starting with emergency management and ending 24 hours after embolization.
Results: A significant correlation (P<0.001) was found between the pattern of pelvic ring disruption and the occurence of pelvic arterial bleeding; of 29 patients, 19 showed type-C-lesions with vertical instability. Superior gluteal arteries and internal pudendal arteries were found to be the most common arterial bleeding source (11 times each), followed by obturator (6 times) and lateral sacral arteries (5 times). In every patient, arterial pelvic bleeding was stopped by selective embolization, which was followed by a significant reduction in the need for blood products. Before embolization, a mean of 13.5 ± 7.0 units of red blood cell concentrate were transfused, compared with 3.2 ± 2.5 units after embolization (P<0.01).
Discussion and Conclusions: Localized arterial hemorrhage that occurred with major pelvic trauma was stopped with selective embolization in each case. Especially with type C lesions that are accompanied by hemodynamic instability, embolization has proved its worth as part of a comprehensive therapy concept.