Bilateral Versus Unilateral Arterial Embolization in Pelvic Trauma: A ReCONNECT Study

Area of Science:

• Trauma Surgery
• Interventional Radiology
• Vascular Medicine

Background:

• Pelvic trauma frequently causes hemorrhage, often managed with pelvic artery embolization (PAE).
• The choice between unilateral and bilateral PAE for optimal outcomes remains debated.
• This study investigates the comparative efficacy and safety of unilateral versus bilateral PAE in pelvic trauma patients.

Purpose of the Study:

• To compare 7-day mortality rates between unilateral and bilateral PAE in patients with pelvic trauma.
• To evaluate secondary outcomes including complications and reinterventions.
• To identify predictors of 7-day mortality in this patient cohort.

Main Methods:

• A multicenter prospective observational study included 117 adult patients undergoing PAE for pelvic trauma between 2018 and 2022.
• Patients with unilateral or no hemorrhage on initial angiography were analyzed.
• Primary outcome was 7-day mortality; secondary outcomes included complications and reintervention rates. Multivariate analysis was performed.

Main Results:

• Sixty-eight patients (58.1%) underwent unilateral PAE and 49 (41.9%) underwent bilateral PAE.
• The bilateral PAE group had a higher median Injury Severity Score and increased rates of acute kidney injury and venous thromboembolism.
• No significant difference in 7-day mortality was observed between unilateral and bilateral PAE groups (P = 0.454).

Conclusions:

• Unilateral and bilateral PAE exhibit comparable efficacy regarding 7-day mortality in pelvic trauma.
• Bilateral PAE is associated with a higher incidence of acute kidney injury and venous thromboembolism.
• Unilateral PAE may be the more suitable approach when bilateral hemorrhage is not evident.