Selective Transcatheter Arterial Embolization of the Internal Iliac Artery Does Not Cause Gluteal Necrosis in Pelvic Trauma Patients

Abstract

The aim of this study is to determine if selective transcatheter arterial embolization (TAE) of the branches of the internal iliac artery in patients with pelvic trauma is a risk for gluteal necrosis. Retrospective chart review. Civilian Level I trauma center. Twenty patients with pelvic fractures and hemorrhage. Selective and nonselective TAE of the internal iliac artery and its branches. The location of all fractures was identified as well as the fracture type. Selective TAE was also distinguished from nonselective TAE. Orthopaedic surgical intervention was recorded. Cases of gluteal necrosis and wound infection were recorded as well as renal failure and anaphylactic reaction to intravenous contrast. Of the 551 patients identified with pelvic fractures, 20 patients were identified to have undergone TAE from January 2004 to January 2009. Of these, 18 cases were treated with selective TAE and two with nonselective unilateral TAE. No complications of gluteal muscle or pelvic skin necrosis, wound infection, renal failure, or anaphylaxis were noted in any of these cases. Average patient age was 55 years with average Injury Severity Score 17. Eleven cases underwent orthopaedic surgical procedures, eight of which involved open reduction and internal fixation of the acetabulum or hemiarthroplasty of the hip. Selective TAE of internal iliac branches including the gluteal arterial branches appears to be safe in patients with pelvic and acetabular fractures with and without orthopaedic surgical treatment. Nonselective TAE of the internal iliac artery may also be safe when performed unilaterally. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.