Pelvic Trauma: factors predicting arterial hemorrhage and the role of Angiography and preperitoneal pelvic packing
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VASCULAR-INTERVENTIONAL
Pelvic Trauma: factors predicting arterial hemorrhage and the role of Angiography and preperitoneal pelvic packing Jagteshwar Sandhu 1,2
&
Robert Abrahams 3 & Zoe Miller 4 & Shivank Bhatia 4 & Tanya L Zakrison 5 & Prasoon Mohan 4
Received: 3 April 2020 / Revised: 23 April 2020 / Accepted: 15 May 2020 # European Society of Radiology 2020
Abstract Objectives (1) To identify the factors predicting arterial extravasation in pelvic trauma and (2) to assess the efficacy of preperitoneal pelvic packing (PPP) in controlling arterial hemorrhage. Methods Institutional review board approved the retrospective study of 139 consecutive pelvic trauma patients who underwent angiographic intervention with or without prior PPP between January 2011 and December 2016. Patient demographics and presenting characteristics were recorded. Both groups of patients were combined for analysis of predictors for arterial extravasation using univariate logistic regression followed by multivariate logistic regression. Significance level was defined as p < 0.05. Results Forty-nine out of 139 patients had PPP prior to pelvic angiogram. Embolization was performed in 85 (61.2%) patients and the technical and clinical success rate was 100%. Sixty-nine (49.7%) patients had unstable Young-Burgess (Y&B) type fractures, of which 58% had arterial hemorrhage compared with 38.6% of those with stable Y&B fractures (p = 0.02). Of the patients who had PPP prior to angiogram, 28(57.1%) continued to have arterial extravasation on subsequent angiography. Unstable Y&B type fractures are independent predictors of arterial hemorrhage (OR 2.3, 95%CI 1.1 to 4.7, p = 0.02). Conclusion Unstable Y&B type pelvic fractures are predictors of arterial extravasation. PPP alone is not effective for arterial hemorrhage control in pelvic trauma. Angiographic intervention remains a minimally invasive and definitive treatment of arterial hemorrhage from pelvic trauma. Key Points • Unstable Young-Burgess pelvic fractures are predictors of arterial hemorrhage in pelvic trauma. • Pelvic angiography and embolization should precede PPP wherever feasible. Keywords Trauma . Angiography . Pelvis . Hemorrhage . Fracture
Abbreviations APC Anterioposterior compression
* Jagteshwar Sandhu [email protected] 1
University of Miami Miller School of Medicine, Miami, FL, USA
2
University of Miami Hospitals and Clinics, 1475 NW 12th Ave. Suite 1066-V, Miami, FL 33136, USA
3
Diagnostic and Interventional Radiology, Haywood Medical Imaging, Clyde, NC, USA
4
Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
5
Department of Surgery, Jackson Memorial Hospital, Miami, FL, USA
CM LC PPP REBOA VS Y&B
Combined mechanism Lateral compression Preperitoneal pelvic packing Resuscitative endovascular balloon occlusion of the aorta Vertical shear Young and Burgess
Introduction Bleeding pelvic fractures are life-threatening injuries, with mortality ranging from 5 to 26% [1–3]. Hemorrhage ca
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