Traumatic presacral hemorrhage: angiographic diagnosis and therapy

“Interventional angiography.” A possible role in intraoperative balloon occlusion catheterization of lacerated pelvic arteries

“…Unstable posterior ring disruptions involving the ilium, sacroiliac joint, and sacrum in particular are associated with as high as an 18% incidence of mediumsized vessel injury (7), which often results in hemodynamic instability (6). The anterior division (in particular the obturator artery) and the posterior division (giving rise to the iliolumbar, lateral sacral, superior gluteal, and inferior gluteal arteries) of the internal iliac artery are at greatest risk of disruption (16). Rapid control of blood loss is a major concern to the trauma team in the early resuscitation of the polytraumatized patient.…”

“…In fact, the current standard of treatment for retroperitoneal medium-sized vessel lacerations suspected at the time of laparotomy is angiographic embolization (10,11,16,17). Autogenous blood clot or Gelfoam injected through the catheter is a commonly employed technique (4,10,16,17).…”

“…Autogenous blood clot or Gelfoam injected through the catheter is a commonly employed technique (4,10,16,17). It is felt that the use of particulate embolization may help prevent recurrence of hemorrhage through distal collateral circulation as may occur when balloons or coils are used (16,18). However, the risk of inadvertent reflux of embolizing material and subsequent unintentional embolization of other noninvolved areas has been reported when using particulate matter (5).…”

“…However, in the management of arterial injury with associated retroperitoneal hematoma, the efficacy of transcatheter angiographic embolization has been documented by many previous investigators (1,3,4,(9)(10)(11)(12)(15)(16)(17)(18). In fact, the current standard of treatment for retroperitoneal medium-sized vessel lacerations suspected at the time of laparotomy is angiographic embolization (10,11,16,17). Autogenous blood clot or Gelfoam injected through the catheter is a commonly employed technique (4,10,16,17).…”

“…In fact, the current standard of treatment for retroperitoneal medium-sized vessel lacerations suspected at the time of laparotomy is angiographic embolization (10,11,16,17). Autogenous blood clot or Gelfoam injected through the catheter is a commonly employed technique (4,10,16,17). It is felt that the use of particulate embolization may help prevent recurrence of hemorrhage through distal collateral circulation as may occur when balloons or coils are used (16,18).…”