Pelvic trauma and vascular emergencies

Abstract

Pelvic ring injuries carry a high mortality rate, the main cause of which, in the first 24hours, is exsanguination. Injured patients are managed by a multidisciplinary damage-control strategy. Unstable patients should have instrumentalized hemostasis without delay. Arterial embolization is an effective way of achieving this and justifies this approach being permanently available in level 1 trauma-centers. After CT assessment of injuries, stable patients can undergo arterial embolization if active arterial bleeding or vascular damage is present. The embolization methods (selective or unselective) and agents used depend on the patient's hemodynamic stage and assessment of the injury whenever possible.

Analysis of the Importance of Sacroiliac Joint Fractures as a Prognostic Factor of the Patients with Pelvic Fractures

“…Most venous hemorrhages could be managed non-operatively. When arterial bleeding was combined with pelvic fracture, hemodynamic instability was frequent, and hemostasis was required [12]. Young et al [2] reported that a particular pelvic fracture pattern is associated with a major ligamentous disruption related to arterial bleeding.…”

“…Such an event is diagnosed as blushing on CT or angiography. Scemama et al [12] reported that 75% of the cases of hemorrhage requiring angiography in the presence of contrast leakage were detected on CT scan. Angiography and embolization are effective in stopping arterial bleeding [8][9][10][11]17,18].…”

“…Traumatic pelvic fractures may result in severe hemorrhage and death. The pelvic fracture-related mortality rate has been reported to be up to 15% [10][11][12][13][14][15][16]. The treatment modality depends on the injury mechanisms, clinical features, and radiological fracture patterns [11].…”

“…The reported overall mortality rates for these patients vary; however, there is a broad agreement that death as a direct result of pelvic fractures occurs in less than 1% of patients admitted due to this injury. However, the mortality rate is high in patients with pelvic fractures combined with head and thoracoabdominal injuries [12,[17][18][19][20][21].…”

Vascular emergencies: Diagnosis and treatment

“…• subarachnoid hemorrhages and intracranial aneurysms [1][2][3]; • multiple injuries -damage to the aorta and its branches [4][5][6][7]; • gastrointestinal hemorrhage both from arterial causes and from portal hypertension [8,9]; • rupture of aneurysms of visceral branches of the aorta [10]; • the specific treatment of postoperative or postinterventional radiology and soft tissue oncology bleeding [11][12][13][14]; • hemoptysis and epistaxis [15,16].…”