Transcatheter embolotherapy after external surgical stabilization is a valuable treatment algorithm for patients with persistent haemorrhage from unstable pelvic fractures: Outcomes of a single centre experience

Abstract

PurposeThe management of hemodynamically unstable patients with severe pelvic fractures remains a challenge. Various treatment strategies have been advocated. This study analyzed the value of transcatheter angiographic embolization (TAE) for persistent haemodynamic instability after initial fracture stabilization. Materials and methodsFrom January 2002 to July 2011, 803 patients were identified with pelvic fractures, 295 of them (37%) were presenting with unstable pelvic fractures. Fifteen patients, all with unstable fractures (2%), remained hypotensive (systolic blood pressure<90mmHg) despite adequate fluid resuscitation and emergent surgical fracture stabilization, subsequently underwent TAE. ResultsThe median age in the TAE-group was 57.9 years±20.12 (min 22; max 82) and the median ISS (injury severity score) was 35.8±11.7 (min 22; max 66). 13 out of 15 patients (87%) received initial external fixation and 2 patients (13%) where treated with a C-Clamp before TAE. Radiological success, defined as absence of contrast extravasation on completion angiography, was observed in all 15 patients. In total 3 (20%) patients died during the period of hospitalization, none of them owing to persistent or recurrent pelvic haemorrhage. In the remaining 12 patients, no early or late complications of TAE were identified. Preperitoneal pelvic packing was performed in two patients, both had open pelvic fractures. ConclusionTAE is a safe and very efficient procedure to treat persistent haemorrhage in patients with unstable pelvic fractures initially treated by surgical fracture stabilization procedures. On the long term, no early or late bleeding recurrence could be demonstrated with an overall survival rate of 80%. Preperitoneal pelvic packing can be reserved for patients with open fractures and active bleeding.