Abstract
PurposeTo validate our previously designed transcatheter arterial embolization (TAE) technique for bilateral iliac arteries in unstable pelvic fractures, which is designed to also prevent gluteal necrosis and avoid vasopressors.MethodsWe retrospectively analyzed the data of patients with pelvic fractures who underwent our new TAE procedure to determine the incidence of subsequent gluteal necrosis. We also compared certain variables between patients who underwent TAE before 2005 using a different technique and developed gluteal necrosis and patients who underwent TAE in 2005 and onward using our technique. Gluteal necrosis was confirmed by a radiologist based on imaging findings.ResultsSeventy patients with pelvic fractures who underwent our TAE technique met the inclusion criteria (bilateral iliac arterial embolization and no embolic agent other than a gelatin sponge). Patients’ median age was 47.5 years, 33 were male, and 92.9% (65/70) had unstable fractures. Sixty-eight patients had severe multiple trauma. No patients developed gluteal necrosis following our TAE procedure and the overall survival rate was 82.9% (58/70). We found no statistically significant difference in procedure time between the previous and new technique, although the new procedure tended to be shorter. Furthermore, overall survival did not significantly differ between the groups. Multiple regression analysis revealed that TAE procedure time and external pelvic fracture fixation were independently related to gluteal necrosis.ConclusionsOur non-selective bilateral iliac arterial embolization procedure involves arresting shock quickly, resulting in no post-procedure gluteal necrosis. The procedure involves cutting the gelatin sponge rather than “pumping” and avoids the use of vasopressors.
Highlights
Pelvic fractures are a relatively common fatal injury resulting from various types of trauma, including traffic accidents and falls
Pelvic fractures for which transcatheter arterial embolization (TAE) was performed at our facility were treated with the previously described new TAE strategy
We excluded 23 patients who were treated with selective embolization and 2 patients treated with an embolic agent other than gelatin sponge (GS)
Summary
Pelvic fractures are a relatively common fatal injury resulting from various types of trauma, including traffic accidents and falls. They cause massive retroperitoneal bleeding, and the mortality rate for patients with hemodynamic instability due to pelvic fractures remains at approximately 30% [1]. Pelvic fractures are treated by combining mechanical stabilization of the fractured region using temporary external fixation devices or external pelvic fixation, transcatheter arterial embolization (TAE), or preperitoneal pelvic packing (PPP). Over 80% of hemorrhage cases in pelvic fractures originate at the vein and bone surfaces [2]. It is certain that mechanical fixation of the pelvis is important because pelvic instability
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