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

Traumatic hemorrhage from pelvic injury presents a significant challenge, and pelvic artery embolization (PAE) is often utilized for bleeding control. The optimal approach of unilateral or bilateral embolization remains unclear. We hypothesized that there would be no difference in 7-d mortality in patients undergoing unilateral versus bilateral PAE for pelvic trauma.

A multicenter prospective observational study was conducted on adult patients who underwent PAE at six trauma centers between 2018 and 2022. Patients were included if they had unilateral or no hemorrhage on initial pelvic angiogram and underwent embolization. The primary outcome was 7-d mortality. Secondary outcomes included complications and reinterventions. A multivariate analysis was conducted to identify predictors of 7-d mortality.

Of the 117 patients included in the study, 63 (53.8%) had unilateral arterial hemorrhage, and 54 (46.2%) had no arterial hemorrhage on angiography. Sixty-eight patients (58.1%) underwent unilateral PAE, and 49 patients (41.9%) underwent bilateral PAE. The median Injury Severity Score was significantly higher in the bilateral PAE group (P = 0.002). There were significantly higher rates of acute kidney injury (P = 0.039) and venous thromboembolism (P = 0.050) in the bilateral PAE group. There was no significant difference in 7-d mortality (P = 0.454). No significant association was found between unilateral or bilateral PAE and 7-d mortality after controlling for covariates.

Unilateral and bilateral PAE demonstrated similar efficacy and 7-d mortality. Bilateral PAE was associated with higher rates of acute kidney injury and venous thromboembolism. Unilateral PAE may be more appropriate in the absence of bilateral hemorrhage.