Transcatheter Arterial Embolizations of Arterial Bleeding in Patients with Pelvic Bone Fracture

Abstract

Purpose : To evaluate the usefulness of transcatheter arterial embolization (TAE) of arterial bleeding in patients with pelvic bone fracture.Materials and Methods : We retrospectively evaluated 13 injured arteries of seven patients with pelvic bone fracture. In order to evaluate the sites and types of arterial injuries, angiography was performed, followed by TAE using Gelfoam and a coil. The parameter of technical success is non-visualization of extravasation and pseudoaneurysm in injured arteries. We investigated (1) the survival rate and complications of TAE; (2) the relationship of arterial injuries to findings, as seen on plain film; and (3) the influence of BP on arrival and the time interval between trauma and TAE on prognosis.Results : Angiography revealed (1) extravasation of contrast media in four patients; (2) extravasation and pseudoaneurysm in two; and (3) extravasation and abrupt cut-off of an artery in one. The injured arteries involved(n=13), were the internal iliac (n=3), superior gluteal (n=3), inferior gluteal (n=2), obturator (n=2), iliolumbar(n=2), and internal pudendal (n=1). TAE was technically successful and in no case were there complications.Vital signs improved in four patients, but three others died due to hypovolemia. In five patients the site of arterial injury, as seen on plain films, was consistent pelvic bone fracture but in one patient more severe arterial injury was noted at the contralateral side of more severe pelvic bone fracture, and in one other arterialinjury was observed only at the contralateral side of pelvic bone fracture. In this study, BP at arrival was a more important prognostic indication than was the time interval between trauma and TAE.Conclusion : For the management of arterial bleeding after blunt pelvic trauma, TAE is the procedure of choice.