Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

Abstract

Purpose:To determine the efficacy of embolization with super-selective catheterization of the internal iliac arterial branches to treat heavily injured trauma patients with pelvic arterial bleeding. Materials and Methods: A retrospective analysis was performed using the medical records of 37 patients who underwent trans-arterial embolization for trauma-associated pelvic arterial hemorrhage in a regional trauma center between July 2010 and July 2013. In each patient, hemodynamic stability, embolization level, elapsed time for trans-arterial embolization, clinical outcome and embolization-related complications were evaluated. Comparison of elapsed time, and presence of complication was done according to embolization level. Results: Transarterial embolization was conducted in 37 patients. Hemodynamic stability of each patient was classified into hemodynamic stable (n = 9), and unstable (n = 28). Twenty-nine of 37 patients underwent embolization after super-selective catheterization of more than 2nd order branch of internal iliac artery with a microcatheter, and 8 patients underwent proximal internal iliac artery embolization without super-selective catheterization. The mean elapsed procedure time for super-selective embolization (34.76 ± 20.0 minutes) was not significantly longer than proximal internal iliac artery embolization (33.87 ± 16.73 minutes, p = 0.215). Conclusion: Pelvic arterial embolization with super-selective catheterization is a safe and feasible treatment for heavily injured patients with trauma-associated pelvic arterial bleeding.

Transcatheter Arterial Embolization for Bleeding Related to Pelvic Trauma: Comparison of Technical and Clinical Results between Hemodynamically Stable and Unstable Patients

“…Some authors have advocated prophylactic embolization for time-sensitive scenarios such as cases of hemodynamic instability in particularly bad clinical conditions or other associated lifethreatening medical conditions [4,25]. Instead, other authors have demonstrated that selective targeted embolization is as rapid as proximal embolization [78]. Another scenario is the hemodynamically unstable patient, without other sources of extra-pelvic bleeding and no evidence of active extravasation on angiography: the pattern of pelvic injury can also be helpful in predicting the site of arterial injury [79].…”

Endovascular Management of Pelvic Trauma: The Interventional Radiology Point of View

“…Moreover, the increased risk of ischemia given by non-selective embolization is mitigated by the rich collateral network present in this anatomical region [1]. Other authors, however, assert that selective embolization may be carried out as quickly as proximal embolization without reducing the survival rate of trauma patients [30].…”

Proposal of standardization of every step of angiographic procedure in bleeding patients from pelvic trauma

“…Non-selective embolization, according to some authors, is indicated to minimize the procedure time when the patient is unstable or has multiple other life-threatening injuries. However, according to other authors, selective embolization for pelvic hemorrhage is not a time-consuming procedure and can be done as rapidly as proximal embolization, without lowering the survival rate for trauma victims [ 40 ].…”