Application of intravascular interventional embolization in emergency treatment of hemodynamically unstable pelvic fracture

Abstract

Objective To evaluate the value of intravascular interventional embolization in the emergency treatment of patients with hemodynamically unstable pelvic fracture. Methods The retrospective analysis was made on the medical records of 45 cases treated from October 2012 to December 2014. There were 27 male and 18 females(39.2±10.3) years (range, 28-54 years). Time from injury to admission was within 3 h. Injury severity score (ISS) was (25.3±8.1)points. The pelvic fracture included 32 cases of Type B and 13 Type C according to Tile classification system. After admission, anti-shock treatment and pelvic immobilization with the belt or external fixator were performed, and emergent intravascular interventional embolization was used to stanch bleeding after the bleeding of other organs was excluded. Vascular intervention, post-treatment vitazl signs and prognosis were evaluated. Results Time from admission to interventional therapy was 1.2-2.7 h[(1.9±0.8)h]. Time of interventional treatment was 1.6-3.2 h [(2.3±0.6)h]. Of the 45 cases, contrast extravasation was seen in 38 cases, abnormal vascular morphology in 5 cases, no obvious bleeding in 1 case, and contrast extravasation in the angiographic venous phase in 1 case. Among the 38 cases of contrast extravasation, the offending vessels involved were internal pudenda artery (26 cases), obturator artery (16 cases), superior gluteal artery (4 cases), inferior gluteal artery (4 cases), inferior epigastric artery (1 case) and external iliac artery (1 case), but 8 cases were noted to have two offending vessels and 1 case had delayed bleeding. Of the 45 cases, the hemostatic effect was good in the early stage. After the interventional embolization therapy, the heart rate was (105.2±14.8) beats/min, arterial pressure was (79.0±10.6)mmHg, central venous pressure was (5.1±0.8)cmH2O, and shock index was 1.1±0.5, showing improved vital signs postoperatively (P<0.05). Four cases died mainly due to the multiple organ failure. One case had abdominal distention aggravated 3 days after operation, which were confirmed to be bleeding in the branch of external iliac artery, and the symptom was alleviated after embolization therapy. Forty-one cases survived with ICU length of stay of (14.5±5.4) d, hospitalization time of (35.2±12.8) d and medical expense of (96, 755.3±20, 568.1) CNY. Conclusion In the emergency treatment of patients with hemodynamically unstable pelvic fracture, the intravascular interventional embolization has become an important measure of comprehensive treatment that allows fast and mini-invasive procedure hemostasis, and deserves clinical promoting. Key words: Hemodynamics; Pelvis; Fractures; Embolization, therapeutic