Endovascular Management of Pelvic Trauma

Husameddin El Khudari; Ahmed Kamel Abdel Aal

doi:10.1055/s-0041-1725112

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2021; 38(01): 123-130
DOI: 10.1055/s-0041-1725112

Review Article

Endovascular Management of Pelvic Trauma

Authors

Husameddin El Khudari

¹Division of Interventional Radiology, Department of Radiology, The University of Alabama at Birmingham (UAB), Birmingham, Alabama
Ahmed Kamel Abdel Aal

²Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas

Abstract

Major pelvic fractures result from high-energy trauma including traffic accidents and falls, which usually leads to multiple injuries complicating the patient's management. Management of these patients requires a coordinated multidisciplinary approach. Transcatheter embolization is a minimally invasive and effective technique to control massive hemorrhage and can be performed using a variety of embolic agents. It has become an accepted first-line management option for retroperitoneal bleeds in many centers. In this article, the indications for endovascular management of hemorrhage from pelvic trauma, the various embolization techniques, and potential complications will be discussed.

Keywords

interventional radiology - embolization - trauma - pelvic - hemorrhage

Full Text

References

References
1 van der Vlies CH, Saltzherr TP, Reekers JA, Ponsen KJ, van Delden OM, Goslings JC. Failure rate and complications of angiography and embolization for abdominal and pelvic trauma. J Trauma Acute Care Surg 2012; 73 (05) 1208-1212
2 Sathy AK, Starr AJ, Smith WR. et al. The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surg Am 2009; 91 (12) 2803-2810
3 Hoffer EK. Transcatheter embolization in the treatment of hemorrhage in pelvic trauma. Semin Intervent Radiol 2008; 25 (03) 281-292
4 Sandhu J, Abrahams R, Miller Z, Bhatia S, Zakrison TL, Mohan P. Pelvic trauma: factors predicting arterial hemorrhage and the role of angiography and preperitoneal pelvic packing. Eur Radiol 2020; 30 (11) 6376-6383
5 Wijffels DJ, Verbeek DO, Ponsen KJ, Carel Goslings J, van Delden OM. Imaging and endovascular treatment of bleeding pelvic fractures: review article. Cardiovasc Intervent Radiol 2019; 42 (01) 10-18
6 Eastridge BJ, Starr A, Minei JP, O'Keefe GE, Scalea TM. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma 2002; 53 (03) 446-450 , discussion 450–451
7 Matsushima K, Piccinini A, Schellenberg M. et al. Effect of door-to-angioembolization time on mortality in pelvic fracture: every hour of delay counts. J Trauma Acute Care Surg 2018; 84 (05) 685-692
8 Tesoriero RB, Bruns BR, Narayan M. et al. Angiographic embolization for hemorrhage following pelvic fracture: Is it “time” for a paradigm shift?. J Trauma Acute Care Surg 2017; 82 (01) 18-26
9 O'Neill PA, Riina J, Sclafani S, Tornetta III P. Angiographic findings in pelvic fractures. Clin Orthop Relat Res 1996; (329) 60-67
10 Brasel KJ, Pham K, Yang H, Christensen R, Weigelt JA. Significance of contrast extravasation in patients with pelvic fracture. J Trauma 2007; 62 (05) 1149-1152
11 Dreizin D, Bodanapally U, Boscak A. et al. CT prediction model for major arterial injury after blunt pelvic ring disruption. Radiology 2018; 287 (03) 1061-1069
12 Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR. Preperitoneal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma 2007; 62 (04) 834-839 , discussion 839–842
13 Ertel W, Keel M, Eid K, Platz A, Trentz O. Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma 2001; 15 (07) 468-474
14 Bonde A, Velmahos A, Kalva SP, Mendoza AE, Kaafarani HMA, Nederpelt CJ. Bilateral internal iliac artery embolization for pelvic trauma: effectiveness and safety. Am J Surg 2020; 220 (02) 454-458
15 Herskowitz M, Walsh J, Lilly M, McFarland K. Importance of both internal and external iliac artery interrogation in pelvic trauma as evidenced by hemorrhage from bilateral corona mortis with unilateral aberrant origin off the external iliac artery. Case Rep Radiol 2019; 2019: 6734816
16 Henning P, Brenner B, Brunner K, Zimmermann H. Hemodynamic instability following an avulsion of the corona mortis artery secondary to a benign pubic ramus fracture. J Trauma 2007; 62 (06) E14-E17
17 Ten Broek RP, Bezemer J, Timmer FA, Mollen RM, Boekhoudt FD. Massive haemorrhage following minimally displaced pubic ramus fractures. Eur J Trauma Emerg Surg 2014; 40 (03) 323-330
18 Hymel A, Asturias S, Zhao F. et al. Selective versus nonselective embolization versus no embolization in pelvic trauma: a multicenter retrospective cohort study. J Trauma Acute Care Surg 2017; 83 (03) 361-367
19 Sheridan MK, Blackmore CC, Linnau KF, Hoffer EK, Lomoschitz F, Jurkovich GJ. Can CT predict the source of arterial hemorrhage in patients with pelvic fractures?. Emerg Radiol 2002; 9 (04) 188-194
20 Slater SJ, Barron DA. Pelvic fractures - a guide to classification and management. Eur J Radiol 2010; 74 (01) 16-23
21 Vaidya S, Tozer KR, Chen J. An overview of embolic agents. Semin Intervent Radiol 2008; 25 (03) 204-215
22 Abada HT, Golzarian J. Gelatine sponge particles: handling characteristics for endovascular use. Tech Vasc Interv Radiol 2007; 10 (04) 257-260
23 Lopera JE. Embolization in trauma: principles and techniques. Semin Intervent Radiol 2010; 27 (01) 14-28
24 Velmahos GC, Chahwan S, Hanks SE. et al. Angiographic embolization of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis. Am Surg 2000; 66 (09) 858-862
25 Sieber PR. Bladder necrosis secondary to pelvic artery embolization: case report and literature review. J Urol 1994; 151 (02) 422
26 Obaro RO, Sniderman KW. Case report: avascular necrosis of the femoral head as a complication of complex embolization for severe pelvic haemorrhage. Br J Radiol 1995; 68 (812) 920-922
27 Maruhashi T, Kashimi F, Kotoh R. et al. Novel transcatheter arterial embolization method for hemodynamically unstable pelvic fractures to prevent complications of gluteal necrosis. Eur J Trauma Emerg Surg 2020; 46 (05) 1129-1136
28 Travis T, Monsky WL, London J. et al. Evaluation of short-term and long-term complications after emergent internal iliac artery embolization in patients with pelvic trauma. J Vasc Interv Radiol 2008; 19 (06) 840-847
29 Matityahu A, Marmor M, Elson JK. et al. Acute complications of patients with pelvic fractures after pelvic angiographic embolization. Clin Orthop Relat Res 2013; 471 (09) 2906-2911
30 Ramirez JI, Velmahos GC, Best CR, Chan LS, Demetriades D. Male sexual function after bilateral internal iliac artery embolization for pelvic fracture. J Trauma 2004; 56 (04) 734-739 , discussion 739–741
31 Harwood PJ, Grotz M, Eardley I, Giannoudis PV. Erectile dysfunction after fracture of the pelvis. J Bone Joint Surg Br 2005; 87 (03) 281-290
32 Lai CY, Tseng IC, Su CY. et al. High incidence of surgical site infection may be related to suboptimal case selection for non-selective arterial embolization during resuscitation of patients with pelvic fractures: a retrospective study. BMC Musculoskelet Disord 2020; 21 (01) 335
33 Tanizaki S, Maeda S, Matano H, Sera M, Nagai H, Ishida H. Time to pelvic embolization for hemodynamically unstable pelvic fractures may affect the survival for delays up to 60 min. Injury 2014; 45 (04) 738-741