Gluteal muscle necrosis following transcatheter angiographic embolisation for retroperitoneal haemorrhage associated with pelvic fracture

Takahira, Naonobu; Shindo, Mitsuko; Tanaka, Keiji; Nishimaki, Hiroshi; Ohwada, Takashi; Itoman, Moritoshi

doi:10.1016/s0020-1383(00)00098-x

Cited by 91 publications

(57 citation statements)

References 18 publications

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“…In a study performed by Takahira et al [14], which examined the incidence of gluteal necrosis after PAE, five of 151 (3.3%) patients treated with PAE developed gluteal necrosis. Three of these patients (60%) died as a consequence of sepsis and disseminated intravascular coagulation.…”

Section: Discussionmentioning

confidence: 99%

“…Complications previously associated with PAE, including gluteus muscle necrosis [13,14,19], bladder necrosis [12], skin necrosis [6], impotence [7], and surgical wound complications [15], were noted.…”

Section: Methodsmentioning

confidence: 99%

“…Although PAE is considered by many to be a safe procedure with minimal short-term complications [10,16,17], the loss of blood supply to the end organ can result in significant consequences. Complications such as gluteal [13,14,19], bladder [12], femoral head [9], and skin necrosis [6] all have been reported in association with PAE. Moreover, paresis [4], impotence [7], and surgical wound complications [15] have also been described after embolization in the pelvic region.…”

Section: Introductionmentioning

confidence: 99%

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Acute Complications of Patients With Pelvic Fractures After Pelvic Angiographic Embolization

Matityahu¹,

Marmor²,

Elson³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Hemodynamically unstable patients with a pelvic fracture and arterial pelvic bleeding frequently are treated with pelvic angiographic embolization (PAE). PAE is reported to be a safe and effective method of controlling hemorrhage. However, the loss of blood supply and subsequent ischemia from embolization may lead to adverse consequences. Objectives/purposes We sought to determine (1) the frequency and types of complications observed after PAE;(2) the mortality after PAE; and (3) the clinical factors associated with complications and mortality after PAE. Methods We conducted a retrospective case series descriptive study at a Level I trauma center. Using our institution's trauma registry, we isolated patients with pelvic fractures treated with PAE admitted between June 1999 and December 2007. Complications attributed to PAE occurring in the initial hospital stay were recorded. We identified 98 patients with pelvic fractures treated by PAE with an average hospital stay of 25.3 days. Results The complication rate was 11% and included six patients with gluteal muscle necrosis (6%), five with surgical wound breakdown (5%), four deep infections (4%), one superficial infection, two patients with of impotence (2%), and one with bladder necrosis. The mortality rate in the PAE group reached 20%. Bilateral embolization was performed in 100% of the patients with complications.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Complications of Patients With Pelvic Fractures After Pelvic Angiographic Embolization

Matityahu¹,

Marmor²,

Elson³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Although TAE is one of the most useful modalities for con- ma, it may be associated with various complications, including puncture site hematoma, impotence, iliofemoral embolization, paraparesis, and ischemic necrosis of the bladder wall, gluteal skin, femoral head, gluteal muscle, and colon (6)(7)(8)(9)(10)(11)(12)(13). Super-selective catheterization of injured vessels may be a good option for avoiding complications related to TAE, because the blood flow to adjacent structures can be maintained by selectively embolizing only the injured vessel.…”

Section: Introductionmentioning

confidence: 99%

“…Gluteal muscle necrosis after proximal embolization at the internal iliac artery level is most frequently reported, and its estimated incidence is about 6% (7,8,(10)(11)(12)(13). Surgical wound break down (12), pelvic organ infarction, including colon, ileum, ureter, and rectum (7,9), and neurologic complications, such as lower limb paresis, sacral plexus palsy, and sciatic palsy (9), have also been reported.…”

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confidence: 99%

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

Park

Yim

Kim

et al. 2016

J Korean Soc Radiol

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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.

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Traumatologie Achsenskelett

Stäbler¹

Handbuch Diagnostische Radiologie

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Verletzungen der Wirbelsäule können erhebliche Bedeutung für die Betroffenen haben, da von ihnen die Möglichkeit einer Querschnittslähmung ausgeht. Auch setzt eine funktionierende Körperstatik eine intakte, stabile Wirbelsäule voraus. Wegen der komplexen Biomechanik und Anatomie und der Notwendigkeit der raschen und umfassenden Diagnosestellung sind die Anforderungen an die Bildgebung der Wirbelsäule hoch. Oft ist es erforderlich, schnell zu entscheiden, ob überhaupt eine Wirbelsäulenverletzung vorliegt,ob die Verletzung stabil oder instabil ist, ob mehrere Segmente betroffen sind und in welchem Ausmaß knöcherne, ligamentäre und neurogene Strukturen verletzt sind. Die Verletzungen des Os sacrum und des Beckens werden zusammen mit den Verletzungen der Wirbelsäule dargestellt,während das Kapitel über die Frakturen des Acetabulums und am proximalen Femur den Verletzungen des Gliedmaßenskeletts zugeordnet ist. Anatomie der Wirbelsäule und WirbelAls zentral gelegenes Achsenskelett ermöglicht die Wirbelsäule den aufrechten Gang. Größtmögliche Stabilität bei weitgehender Beweglichkeit soll gewährleistet werden, indem sie das Körpergewicht trägt, aber auch zielgerichtete Bewegungen möglich macht. Sie formt darüber hinaus den knöchernen Spinalkanal, in dem das Myelon vor Verletzungen geschützt wird. Die Wirbelsäule und die ihr anhängenden Weichteile sind zusätzlich ein wichtiges Sinnes-und Regelorgan. Die Halswirbelsäule (HWS) verfügt über die größte Beweglichkeit aller Wirbelsäulenabschnitte. Sie muss hierbei allerdings nur das Gewicht des Kopfes kontrollieren. Die Brustwirbelsäule (BWS) ist durch die Rippen, die Schutz für die lebenswichtigen Organsysteme Kreislauf und Atmung bieten, in ihrer Beweglichkeit stark eingeschränkt. Einen größeren Bewegungsumfang ermöglicht die Lendenwirbelsäule (LWS). Die nach kaudal zunehmende Gewichtsbelastung und die lumbale und lumbosakrale Lordosierung ergeben eine hohe mechanische Belastung in den lumbalen Bewegungssegmenten. Als Bewegungssegment werden die Definition ̄Bandscheibe, die zwei angrenzenden Wirbelabschlussplatten und die jeweils zu den Gelenken gehörenden Wirbelbogenanteile bezeichnet (Junghanns 1986). Kapitel 3 Traumatische Veränderungen 150 Abb. 3.31. Der zentral lokalisierte Nucleus pulposus hat wegen seines hohen Wassergehalts eine hohe Signalintensität, die Anulus-fibrosus-Fasern im Vergleich hierzu eine deutlich geringere. Auf der rechten Seite (Segment LWK 4/5) sind die Sharpey-Fasern gut erkennbar. In dieser Gewichtung kann die hyaline Knorpelplatte nicht von der knöchernen Abschlussplatte unterschieden werden. Die zentral im Nucleus pulposus erkennbare Zone gering erniedrigter Signalintensität wird als "nuclear cleft" bezeichnet (T2-gewichtete Aufnahme, koronar) Abb. 3.32. Schematische Darstellung der Einstrahlung von Anulus-fibrosus-Lamellen in die hyaline Knorpelplatte. (Nach Lorenz 1994) Abb. 3.33. Schematische Darstellung der schalenartigen Umhüllung des Nucleus pulposus durch die Anulus-fibrosus-Fasern ("closed-pack system"). (Nach Lorenz 1994) Abb. 3.34. Sag...

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Gluteal muscle necrosis following transcatheter angiographic embolisation for retroperitoneal haemorrhage associated with pelvic fracture

Cited by 91 publications

References 18 publications

Acute Complications of Patients With Pelvic Fractures After Pelvic Angiographic Embolization

Acute Complications of Patients With Pelvic Fractures After Pelvic Angiographic Embolization

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

Traumatologie Achsenskelett

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