Angiographic embolization in the treatment of arterial pelvic hemorrhage: evaluation of prognostic mortality-related fac
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ORIGINAL ARTICLE
Angiographic embolization in the treatment of arterial pelvic hemorrhage: evaluation of prognostic mortality-related factors J. Lindahl • L. Handolin • T. So¨derlund M. Porras • E. Hirvensalo
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Received: 31 March 2012 / Accepted: 18 November 2012 / Published online: 6 December 2012 Ó The Author(s) 2012. This article is published with open access at Springerlink.com
Abstract Purpose The control of arterial bleeding associated with pelvic ring and acetabular fractures (PRAF) remains a challenge for emergency trauma care. The aim of the present study was to uncover early prognostic mortalityrelated factors in PRAF-related arterial bleedings treated with transcatheter angiographic embolization (TAE). Methods Forty-nine PRAF patients (46 pelvic ring and three acetabular fractures) with arterial pelvic bleeding controlled with TAE (within 24 h) were evaluated. Results All large arterial disruptions (n = 7) were seen in type C pelvic ring injuries. The 30-day mortality in large vessel (iliac artery) bleeding was higher (57 %) than in medium- or small-size artery bleeding (24 %). Overall 30-day mortality was 29 %. No statistically significant difference in the first laboratory values between the survivors and nonsurvivors was found. However, after excluding patients dying of head injuries (n = 5), a reasonable cut-off value was identified for the base excess (BE; lower than -10 mmol/l) obtained on admission. Conclusions PRAF patients with exsanguinating bleeding from the large pelvic artery have the worst prognosis. Very low BE values (\-10.0 mmol/l) on admission for exsanguinating patients have a negative predictive value for survival, thus anticipating a poor outcome in bleeding
J. Lindahl (&) L. Handolin T. So¨derlund E. Hirvensalo Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland e-mail: [email protected] M. Porras Department of Radiology, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland
controlled with TAE only and an increased risk of death. In critical cases, an aggressive bleeding control protocol prompts extraperitoneal pelvic packing prior to TAE. PRAF-related rupture of the external iliac artery is rare and indicates surgical techniques in controlling and restoring blood supply to the lower leg. Keywords Pelvic fracture Acetabular fracture Massive bleeding Bleeding pelvic arteries Angiographic embolization Mortality
Introduction Pelvic fractures consist of both pelvic ring and acetabular fractures (PRAF). Major pelvic injuries are associated with a high risk of venous and arterial bleeding [1, 2]. Bleeding usually originates from the presacral venous plexus, directly from the cancellous surfaces of the fracture lines, or from the main trunk or branches of iliac vessels [3–5]. In patients with blunt pelvic trauma, exsanguinating extraperitoneal bleeding remains the leading cause of early death during the first 24 h after trauma at hospital [3, 6–10]. Pelvic fracture bl
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