Comparison between laparotomy first versus angiographic embolization first in patients with pelvic fracture and hemoperitoneum: a nationwide observational study from the Japan Trauma Data Bank

Katsura, Morihiro; Yamazaki, Shin; Fukuma, Shingo; Matsushima, Kazuhide; Yamashiro, Toshimitsu; Fukuhara, Shunichi

doi:10.1186/1757-7241-21-82

Cited by 26 publications

(24 citation statements)

References 27 publications

(36 reference statements)

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“…Current treatment strategies use these options in combination; however, the optimal treatment approach remains a subject of debate . Transcatheter arterial embolization is a rapid and established technique for controlling intractable hemorrhage in pelvic fractures . In our patient, the hemodynamic instability suggested ongoing bleeding, although initial contrast‐enhanced CT revealed retroperitoneal hematoma without contrast extravasation.…”

Section: Discussionmentioning

confidence: 82%

“…The treatment options for pelvic fracture hemorrhage include TAE, external fixation, and preperitoneal pelvic packing. Current treatment strategies use these options in combination; however, the optimal treatment approach remains a subject of debate . Transcatheter arterial embolization is a rapid and established technique for controlling intractable hemorrhage in pelvic fractures .…”

Section: Discussionmentioning

confidence: 99%

“…However, conjecture remains regarding the optimal treatment method . Transcatheter arterial embolization is a rapid and established technique for controlling intractable hemorrhage during pelvic fractures . A previous report showed that resuscitative endovascular balloon occlusion of the aorta was useful during the trauma resuscitation for patients severely injured after abdominal or pelvic trauma, which temporarily regulated intra‐abdominal hemorrhage .…”

Section: Introductionmentioning

confidence: 99%

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Temporal intrailiac balloon occlusion for the treatment of intractable pelvic fracture hemorrhage

Ishida

Noborio

Shimahara

et al. 2015

Acute Medicine & Surgery

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Case: A 48-year-old schizophrenic man sustained multiple injuries following a fall. Unstable pelvic fractures were diagnosed in the emergency department. The patient's hemodynamic status was stabilized following bilateral internal iliac artery embolization using a gelatin sponge. However, recurrent bleeding and an expanding retroperitoneal hemorrhage occurred 1 h after transcatheter arterial embolization.Outcome: Using temporal intrailiac balloon occlusion, with preperitoneal gauze packing, the patient's hemodynamic status was stabilized in the intensive care unit. No complications were observed following transcatheter arterial embolization and balloon occlusion. Conclusions:Temporary intrailiac balloon occlusion is a rapid and safe treatment for refractory pelvic hemorrhage, which can be administered simultaneously with other treatments including preperitoneal gauze packing and external fixation.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Temporal intrailiac balloon occlusion for the treatment of intractable pelvic fracture hemorrhage

Ishida

Noborio

Shimahara

et al. 2015

Acute Medicine & Surgery

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“…[ 5 12 13 ] Recent studies have been unable to measure a difference in mortality between surgical packing and angiographic intervention. [ 20 21 25 ]…”

Section: Discussionmentioning

confidence: 99%

Mortality in trauma patients with active arterial bleeding managed by embolization or surgical packing: An observational cohort study of 66 patients

Froberg

Helgstrand

Clausen

et al. 2016

J Emerg Trauma Shock

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Objective:Exsanguination due to coagulopathy and vascular injury is a common cause of death among trauma patients. Arterial injury can be treated either by angiography and embolization or by explorative laparotomy and surgical packing. The purpose of this study was to compare 30-day mortality and blood product consumption in trauma patients with active arterial haemorrhage in the abdominal and/or pelvic region treated with either angiography and embolization or explorative laparotomy and surgical packing.Material and Methods:From January 1st 2006 to December 31st 2011 2,173 patients with an ISS of >9 were admitted to the Trauma Centre of Copenhagen University Hospital, Rigshospitalet, Denmark. Of these, 66 patients met the inclusion criteria: age above 15 years and active arterial haemorrhage from the abdominal and/or pelvic region verified by a CT scan at admission. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, mechanism of injury, ISS, Probability of Survival, treatment modality, 30-day mortality and number and type of blood products applied were retrieved from the TARN database, patient records and the Danish Civil Registration System.Results:Thirty-one patients received angiography and embolization, and 35 patients underwent exploratory laparotomy and surgical packing. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, ISS and Probability of Survival were comparable in the two groups.Conclusion:A significant increased risk of 30-day mortality (P = 0.04) was found in patients with active bleeding treated with explorative laparotomy and surgical packing compared to angiography and embolization when data was adjusted for age and ISS. No statistical significant difference (P > 0.05) was found in number of transfused blood products applied in the two groups of patients.

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“…However, the appropriate acute management of hemodynamically unstable patients with pelvic fractures remains controversial. Arterial embolization (AE) and preperitoneal pelvic packing (PPP) are the commonly used procedures in this setting, although there is no conclusive evidence regarding the superiority of either procedure [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

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

Lai

Tseng

et al. 2020

Preprint

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Background : In most institutions, arterial embolization (AE) remains a standard procedure to achieve hemostasis during the resuscitation of patients with pelvic fractures. However, the actual benefits from AE are controversial. Methods : We retrospectively reviewed data from patients who were treated for closed pelvic fractures at a single center between 2014 and 2017. Data regarding the AE and clinical parameters were analyzed to determine whether poor outcomes could be predicted. Results : During the study period, 545 patients were treated for closed pelvic fractures, including 131 patients who underwent angiography and 129 patients who underwent AE. Nonselective bilateral internal iliac artery embolization (nBIIAE) was the major AE strategy (74%). Relative to the non-AE group, the AE group had higher values for the injury severity score, shock at hospital arrival, and unstable fracture patterns. Furthermore, relative to the non-AE group, the AE group was more likely to require osteosynthesis and experience surgical site infection (SSI). Fourteen patients (10.9%) experienced late complications following the AE intervention, including 3 men who had impotence at the 12-month follow-up visit and 11 patients who experienced SSIs after undergoing AE and osteosynthesis (incidence of SSI: 11/75 patients, 14.7%). Nine of the 11 patients who experienced SSI after AE had undergone nBIIAE. The positive predictive value of contrast extravasation (CE) during computed tomography (CT) was 29.6%, with a negative predictive value of 91.3%. Relative to patients with identifiable CE, patients without identifiable CE during CT had a higher mortality rate (30.0% vs. 11.0%, p = 0.03). Conclusion : Performing AE for pelvic fracture-related hemorrhage may not be the best practice for patients with no CE detected during CT or for unstable patients who do not respond to resuscitation after excluding other sources of hemorrhage. Given the high incidence of SSI following nBIIAE, this procedure should be carefully selected. Other hemostasis procedures, such as preperitoneal pelvic packing, might be appropriate for patients without CE during imaging, based on their high mortality rate.

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Comparison between laparotomy first versus angiographic embolization first in patients with pelvic fracture and hemoperitoneum: a nationwide observational study from the Japan Trauma Data Bank

Cited by 26 publications

References 27 publications

Temporal intrailiac balloon occlusion for the treatment of intractable pelvic fracture hemorrhage

Temporal intrailiac balloon occlusion for the treatment of intractable pelvic fracture hemorrhage

Mortality in trauma patients with active arterial bleeding managed by embolization or surgical packing: An observational cohort study of 66 patients

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

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