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Arterial Embolization Is a Rapid and Effective Technique for Controlling Pelvic Fracture Hemorrhage

Agolini, Stefano F. MD; Shah, Kamalesh MD; Jaffe, James MD; Newcomb, James MD; Rhodes, Michael MD; Reed, James F. III, PhD

The Journal of Trauma: Injury, Infection, and Critical Care: September 1997 - Volume 43 - Issue 3 - p 395-399

Objective To review the success rate of embolization in stopping hemorrhage for unstable patients with severe pelvic fractures, to calculate the time to achieve embolization, and to determine the yield from angiography.

Design Retrospective review of patients admitted to a Level I trauma center with pelvic fractures during a 5-year period.

Materials and Methods Charts were reviewed for Injury Severity Score, age, blood pressure, prothrombin time/partial thromboplastin time, pelvic fracture type, mortality, time to reach the angiography suite, time to achieve embolization, and mechanism of injury.

Measurements and Main Results Of 806 patients admitted with pelvic fractures, 35 underwent pelvic angiography, and 15 (1.9%) required embolization. Embolization was successful for all patients. No deaths resulted from ongoing hemorrhage. Angiography yield in initially unstable patients was 64%. The mean age and initial hemodynamic instability were significantly greater in nonsurvivors. The time from arrival in the trauma bay to arrival in the angiography suite ranged from 50 to 1,140 minutes, and the time spent in the angiography suite performing embolization ranged from 50 to 140 minutes, with an average time of 90 minutes. Patients who were embolized within 3 hours of arrival had a significantly greater survival rate.

Conclusion Only a small percentage of patients with pelvic fractures require embolization, but when it is used, embolization can be 100% effective. Age, time to achieve embolization, and initial hemodynamic instability appear to be important factors in survival.

From the Department of Surgery (S.F.A.), the Division of Trauma/Surgical Critical Care (K.S.), the Radiology Department (J.J., J.N.), and Community Health & Health Studies (J.F.R.), Lehigh Valley Hospital, Allentown, Pennsylvania; and the Department of Surgery (M.R.), Medical Center of Delaware, Newark, Delaware.

Presented at the Pennsylvania Committee on Trauma Resident's Trauma Paper Competition, November 15, 1995, The Hershey Medical Center, Hershey, Pennsylvania.

Address for correspondence: Stefano Agolini MD, Department of Surgery, Lehigh Valley Hospital, Cedar Crest & I-78, P. O. Box 689, Allentown. PA, 18105-1556. No reprints available.

© Williams & Wilkins 1997. All Rights Reserved.