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Intraoperative angioembolization in the management of pelvic-fracture related hemodynamic instability.

Cherry RA, Goodspeed DC, Lynch FC, Delgado J, Reid SJ - J Trauma Manag Outcomes (2011)

Bottom Line: Four of the 6 survivors had unilateral embolization.In contrast, all 6 non-survivors (ISS 29-41) required massive transfusion prior to OR (>6 units PRBCs) with 4 having a based deficit >13.Patients most likely to benefit have a base deficit <13, and do not require massive transfusion prior to IAE or suffer from a vertically unstable pelvis fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Wisconsin Hospital & Clinics Department of Orthopaedics & Rehabilitation 1685 Highland Avenue Madison, WI 53705 (608) 263-9456, USA. rcherry@hmc.psu.edu.

ABSTRACT

Background: This case series report discusses patients presenting with hemorrhage and hemodymanic compromise due to severe pelvic fractures and undergoing intraoperative angioembolization (IAE) with other resuscitative procedures.

Methods: We used portable digital subtraction fluoroscopy units for IAE in patients with severe pelvic hemorrhage and hemodynamic instability (5/03-4/09). Data was collected on demographics, injury severity, resource utilization, and outcomes at our Level 1 trauma center.

Results: There were 6,538 adult admissions with 912 having pelvic fractures and 65 of these undergoing pelvic angioembolization. Twelve hemodynamically compromised patients (10 males, 2 females) had intraoperative pelvic angiography (age: 22-79 years; mean 51.3 ± 17.4). Injury severity score (ISS) was 37.5 ± 8.4 (22-50). Mean emergency department (ED) length of stay (LOS) was 57.4 min ± 47.9 with 10 patients transported directly to the OR and 2 to the SICU prior to OR. Ten of 12 patients underwent exploratory laparotomy followed by angioembolization. Mortality was 50%. Among the 6 survivors (ISS 22 - 50), all had a pre-op CT scan, five had an initial base deficit <13, and four were transfused ≤ 6 units pre-incision/pre-procedure. Four of the 6 survivors had unilateral embolization. In contrast, all 6 non-survivors (ISS 29-41) required massive transfusion prior to OR (>6 units PRBCs) with 4 having a based deficit >13. Three of these patients bypassed CT and five underwent bilateral internal iliac embolization (BIIE).

Conclusions: IAE for severe pelvic hemorrhage can be successfully performed concurrently with exploratory laparotomy, pelvic packing or other resuscitative procedures. Patients most likely to benefit have a base deficit <13, and do not require massive transfusion prior to IAE or suffer from a vertically unstable pelvis fracture.

No MeSH data available.


Related in: MedlinePlus

Patient # 10 - Intraoperative Pelvic Angiogram. Arrows point to areas of active contrast extravasation.
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Figure 2: Patient # 10 - Intraoperative Pelvic Angiogram. Arrows point to areas of active contrast extravasation.

Mentions: Figure 1 is the pelvis x-ray for Patient # 10. This plain film demonstrates a right displaced femoral neck fracture and a left acetabular fracture. Comminuted superior and inferior pubic rami fractures are noted bilaterally. A fracture through the right sacrum is also seen, along with a fracture of the left L5 transverse process. Figure 2 shows active extravasation of contrast from numerous branches of both the anterior division and posterior divisions of both the right and left internal iliac arteries, suggesting multiple bleeding sites. Both internal iliac arteries were embolized with Gelfoam to occlusion.


Intraoperative angioembolization in the management of pelvic-fracture related hemodynamic instability.

Cherry RA, Goodspeed DC, Lynch FC, Delgado J, Reid SJ - J Trauma Manag Outcomes (2011)

Patient # 10 - Intraoperative Pelvic Angiogram. Arrows point to areas of active contrast extravasation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3113950&req=5

Figure 2: Patient # 10 - Intraoperative Pelvic Angiogram. Arrows point to areas of active contrast extravasation.
Mentions: Figure 1 is the pelvis x-ray for Patient # 10. This plain film demonstrates a right displaced femoral neck fracture and a left acetabular fracture. Comminuted superior and inferior pubic rami fractures are noted bilaterally. A fracture through the right sacrum is also seen, along with a fracture of the left L5 transverse process. Figure 2 shows active extravasation of contrast from numerous branches of both the anterior division and posterior divisions of both the right and left internal iliac arteries, suggesting multiple bleeding sites. Both internal iliac arteries were embolized with Gelfoam to occlusion.

Bottom Line: Four of the 6 survivors had unilateral embolization.In contrast, all 6 non-survivors (ISS 29-41) required massive transfusion prior to OR (>6 units PRBCs) with 4 having a based deficit >13.Patients most likely to benefit have a base deficit <13, and do not require massive transfusion prior to IAE or suffer from a vertically unstable pelvis fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Wisconsin Hospital & Clinics Department of Orthopaedics & Rehabilitation 1685 Highland Avenue Madison, WI 53705 (608) 263-9456, USA. rcherry@hmc.psu.edu.

ABSTRACT

Background: This case series report discusses patients presenting with hemorrhage and hemodymanic compromise due to severe pelvic fractures and undergoing intraoperative angioembolization (IAE) with other resuscitative procedures.

Methods: We used portable digital subtraction fluoroscopy units for IAE in patients with severe pelvic hemorrhage and hemodynamic instability (5/03-4/09). Data was collected on demographics, injury severity, resource utilization, and outcomes at our Level 1 trauma center.

Results: There were 6,538 adult admissions with 912 having pelvic fractures and 65 of these undergoing pelvic angioembolization. Twelve hemodynamically compromised patients (10 males, 2 females) had intraoperative pelvic angiography (age: 22-79 years; mean 51.3 ± 17.4). Injury severity score (ISS) was 37.5 ± 8.4 (22-50). Mean emergency department (ED) length of stay (LOS) was 57.4 min ± 47.9 with 10 patients transported directly to the OR and 2 to the SICU prior to OR. Ten of 12 patients underwent exploratory laparotomy followed by angioembolization. Mortality was 50%. Among the 6 survivors (ISS 22 - 50), all had a pre-op CT scan, five had an initial base deficit <13, and four were transfused ≤ 6 units pre-incision/pre-procedure. Four of the 6 survivors had unilateral embolization. In contrast, all 6 non-survivors (ISS 29-41) required massive transfusion prior to OR (>6 units PRBCs) with 4 having a based deficit >13. Three of these patients bypassed CT and five underwent bilateral internal iliac embolization (BIIE).

Conclusions: IAE for severe pelvic hemorrhage can be successfully performed concurrently with exploratory laparotomy, pelvic packing or other resuscitative procedures. Patients most likely to benefit have a base deficit <13, and do not require massive transfusion prior to IAE or suffer from a vertically unstable pelvis fracture.

No MeSH data available.


Related in: MedlinePlus