Complications After Pelvic Arteriography in Patients With Pelvic Ring Disruptions

Wiley, Marcel R.; Black, Sheena R.; Martin, Case; Barnwell, Jonathan; Starr, Adam J.; Sathy, Ashoke K.

doi:10.5435/jaaos-d-17-00198

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…In our cohort, the patients who underwent pelvic arterial embolisation (PAE) showed the worst outcomes in terms of number of surgical procedures required to control SSI and hospitalisation. Arterial embolisation represents an efficient acute intervention to control severe arterial bleeding following pelvic trauma [ 10 ] but potential complications include: gluteal muscle necrosis and skin ulceration, although these are reported to be rare in the literature [ 10 , 52 ]. Manson et al recently reported an increase of deep infection rate after acetabular fracture fixation (up to 58% of cases) in patients who previously underwent pelvic angiographic embolisation.…”

Section: Discussionmentioning

confidence: 99%

Deep infection following reconstruction of pelvic fractures: prevalence, characteristics, and predisposing risk factors

Kanakaris

Ciriello

Stavrou

et al. 2021

Eur J Trauma Emerg Surg

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Purpose To identify the incidence, risk factors, and treatment course of patients who developed deep infection following fixation of pelvic fractures. Methods Over a period of 8 years patients who underwent pelvic reconstruction in our institution and developed postoperative infection were included. Exclusion criteria were pathological fractures and infections that were not secondary to post-traumatic reconstruction. The mean time of follow-up was 43.6 months (33–144). For comparison purposes, we randomly selected patients that underwent pelvic fracture fixation from our database (control group). A logistic regression was fitted to patient characteristics including age, sex, ISS, and diabetic status. Results Out of 858 patients, 18 (2.1%) (12 males), with a mean age of 41 (18–73) met the inclusion criteria. The control group consisted of 82 patients with a mean age of 41 years (18–72). The mean ISS was 27.7 and 17.6 in the infection and control group, respectively. The mean time from pelvic reconstruction to the diagnosis of infection was 20 days (7–80). The median number of trips to theatre was 3 (1–16). Methicillin-resistant Staphylococcus aureus (MRSA) was the most frequently isolated organism in the years prior to 2012. Eradication was achieved in 93% of the patients. The most important risk factors for deep infection were ISS (OR 1.08, 1.03–1.13), posterior sacral approach (OR 17.03, 1.49–194.40), and diabetes (OR 36.85, 3.54–383.70). Conclusion In this retrospective case–control study, deep infection following pelvic trauma was rare. A number of patient-, injury- and surgery-related factors have shown strong correlation with this serious complication.

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Section: Discussionmentioning

confidence: 99%

Deep infection following reconstruction of pelvic fractures: prevalence, characteristics, and predisposing risk factors

Kanakaris

Ciriello

Stavrou

et al. 2021

Eur J Trauma Emerg Surg

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“…Localization of potential arterial injury during pelvic ring fractures can aid in the selective angiography performed during primary treatment of a polytraumatized patient by means of embolizing the bleeding artery (Tosounidis and Giannoudis, 2013;Lustenberger et al, 2015;Scemama et al, 2015;Rudloff and Triantafillou, 2016;Comai et al, 2016;Wiley et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Where and what arteries are most likely injured with pelvic fractures?

et al. 2019

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Blood vessels passing through pelvic region come into intimate contact with pelvic bone and can be injured by the sharp edges of the dislocated fracture fragments. The aim of the study was to evaluate the influence of localization, shape, and dislocation of individual pelvic ring bones' fractures on arterial injuries. The study group consisted of 474 patients enrolled in a 1‐year prospective multicenter study. The pattern of pelvic fracture lines was characterized and recorded on a planar diagram of the subjected side of the pelvis. The diagram was subdivided into 11 designated areas. Frequency of injury at each 11 areas was recorded. The course of individual arteries in the 11 areas was also recorded in relation to each type of pelvic fractures. Out of the 474 investigated patients, the highest proportion of fractures occurred in the areas of the superior (62%) and inferior (59%) ramus of the pubis as well as in the lateral part of the sacrum (19%). These locations can be associated with injuries of the external iliac, obturator, internal iliac, and aberrant obturator arteries. The highest risk of arterial injuries was associated with vertically displaced fractures in the middle part of the superior and inferior pubic rami, along the ischial ramus, in the apex of the greater sciatic notch and in the vicinity of the ventral part of the sacroiliac joint, where the artery runs at a distance of less than 1 cm from the bone. Clin. Anat. 32:682–688, 2019. © 2019 Wiley Periodicals, Inc.

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“…Angiography, however, carries a 20% risk of serious complications that include gluteal necrosis leading to hip disarticulation or hemipelvectomy. 11 In addition, timing remains an issue with the Baltimore group reporting time to embolization being more than 5 hours and potentially contributing to the 80% of deaths attributed to acute exsanguination. 12 Beyond the data that we present, success of our protocol to achieve a reduction in mortality from acute exsanguination relies on the intangible concepts of team and culture.…”

Section: Combine Reducing Pelvic Volumementioning

confidence: 99%

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confidence: 99%