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Pelvic angioembolization: how urgently needed?

Giles Lawrence Devaney1, Kate Louise King1, Zsolt Janos Balogh2

  • 1Division of Surgery, Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
|October 10, 2020
PubMed
Summary

Time to angioembolization (AE) for pelvic fracture bleeding did not improve over 10 years. Despite delays, no patients died from exsanguination, challenging the need for hyperacute AE in trauma care.

Keywords:
AngioembolizationPelvic fracturePolytraumaResuscitation

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Area of Science:

  • Trauma surgery
  • Interventional radiology
  • Emergency medicine

Background:

  • Angioembolization (AE) is crucial for pelvic fracture (PF) hemorrhage control.
  • Concerns exist regarding timely AE availability as a first-line treatment.
  • Hemostatic resuscitation strategies are evolving.

Purpose of the Study:

  • To describe AE utilization patterns in PF patients receiving hemostatic resuscitation.
  • To test the hypothesis that time to AE improved over a decade.
  • To analyze factors influencing time to AE and patient outcomes.

Main Methods:

  • Analysis of a prospective Level-1 trauma center PF database (2009-2018).
  • Inclusion of consecutive PF patients undergoing AE; pelvic packing was not used.
  • Collection of demographics, injury severity, transfusion data, time to AE, and mortality.

Main Results:

  • 36 (2.8%) of 1270 PF patients received AE.
  • Median time to AE was 141 min for clinical suspicion (CS) and 223 min for CT blush, with no significant change.
  • Patients with CS had higher injury severity and transfusion needs, with faster AE times.

Conclusions:

  • Time to AE for PF bleeding did not improve over the study period.
  • Patients referred via CT have different physiological profiles than those with clinical suspicion.
  • No exsanguination deaths occurred despite AE times exceeding 2 hours, questioning the necessity of hyperacute AE.