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Selective versus nonselective embolization versus no embolization in pelvic trauma: A multicenter retrospective
Aimee Hymel1, Sabrina Asturias, Frank Zhao
1From the Department of Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Surgery, University of Southern California (S.A., E.B., G.S.M.), Los Angeles, California; and Department of Surgery, University of Texas Southwestern (F.Z., H.A.P.), Dallas, Texas.
Angioembolization may help control bleeding from pelvic fractures, even with negative angiograms. For positive angiograms, selective embolization is preferred over non-selective embolization to reduce complications.
Area of Science:
- Trauma surgery
- Interventional radiology
- Vascular surgery
Background:
- Traumatic hemorrhage from pelvic fractures presents a significant clinical challenge.
- Angioembolization is a standard treatment, but optimal strategies remain undefined for specific scenarios.
- Uncertainty exists regarding embolization efficacy with negative angiograms and the superiority of selective versus non-selective embolization with positive angiograms.
Purpose of the Study:
- To evaluate the efficacy of embolization in controlling hemorrhage in patients with pelvic fractures and negative angiograms.
- To compare the outcomes of selective embolization (SE) versus non-selective embolization (NSE) in patients with pelvic fractures and positive angiograms.
Main Methods:
- A multicenter retrospective review of blunt trauma patients with pelvic fractures who underwent angiography.
- Data collected included demographics, clinical information, embolization techniques (NSE vs. SE), and complication rates.
- Patients were categorized based on angiogram findings (positive or negative) and embolization strategy.
Main Results:
- In patients with negative angiograms, embolization was associated with decreased transfusion requirements (7.5 vs. 4.0 units).
- Embolization-related complications were more frequent in non-embolized patients with negative angiograms (11.4% vs. 6.0%).
- In patients with positive angiograms, NSE was associated with a significantly increased rate of thromboembolic complications compared to SE (12.1% vs. 0%).
Conclusions:
- Embolization may aid hemorrhage control in patients with pelvic fractures and negative angiograms, particularly those requiring active transfusion.
- Selective embolization of distal vessels is recommended over non-selective embolization of the internal iliac artery to minimize thromboembolic complications.
