Abstract No. 596 Safety and efficacy of dual-layered carotid stent (C guard, Inspire MD) without distal embolic protection device

Abstract

Purpose: Pelvic angiography and embolization has been shown to be the definitive treatment for arterial hemorrhage in pelvic trauma. The Eastern association for the Surgery of Trauma (EAST) states that arterial extravasation on CT angiogram is an indication for pelvic angiography and embolization. The purpose of this study is to evaluate the efficacy of CTA in detecting arterial hemorrhage in pelvic trauma. Materials and Methods: Institutional review board approved retrospective study of 106 pelvic trauma patients who underwent CT angiograms (CTA) who subsequently underwent pelvic angiography between January 2011 and December 2016. Pelvic fractures were graded based on the Young-Burgess Classification. Both groups were combined for analysis of differences using T tests. Significance level was defined at P < 0.05 Results: Twenty-three of 106 patients (21.7%) had negative CTAs. Of those, 8 had arterial extravasation on subsequent pelvic angiography. The overall specificity, sensitivity, positive, and negative predictive values for CTA in this study were 57.7%, 85.9%, 50%, and 65.2%. Based on hemodynamic factors four (50%) of the patients with false negative CTA were in class III/IV shock. The average transfusion requirement for these 8 patients was 3 units of PRBS (SD 2.82). Five (33%)patients in this group had high-grade pelvic fractures. CT findings showed a pelvic hematoma in 6/8 (75%) of the positive group and 9/15 (60%) in the CTA negative group. Angiographic findings showed that 4(50%) had extravasation in the iliolumbar, sacral, or sacral branches of the superior gluteal arteries. The other 4 (50%) had extravasation in the internal pudendal, superior gluteal, and obturator arteries. Conclusions: The negative predictive value of CTA in pelvic trauma is 65.2% and therefore if there are signs of continued bleeding or hemodynamic instability in patients with negative CTA, definitive procedure such as angiography should be considered.