Angiographic embolization in the treatment of arterial pelvic hemorrhage: evaluation of prognostic mortality-related factors

作者：Lindahl J^*; Handolin L; Soderlund T; Porras M; Hirvensalo E

来源：European Journal of Trauma and Emergency Surgery, 2013, 39(1): 57-63.

DOI：10.1007/s00068-012-0242-6

• Pelvic fracture
• Acetabular fracture
• Massive bleeding
• Bleeding pelvic arteries
• Angiographic embolization
• Mortality

Purpose The control of arterial bleeding associated with pelvic ring and acetabular fractures (PRAF) remains a challenge for emergency trauma care. The aim of the present study was to uncover early prognostic mortality-related factors in PRAF-related arterial bleedings treated with transcatheter angiographic embolization (TAE). %26lt;br%26gt;Methods Forty-nine PRAF patients (46 pelvic ring and three acetabular fractures) with arterial pelvic bleeding controlled with TAE (within 24 h) were evaluated. %26lt;br%26gt;Results All large arterial disruptions (n = 7) were seen in type C pelvic ring injuries. The 30-day mortality in large vessel (iliac artery) bleeding was higher (57 %) than in medium- or small-size artery bleeding (24 %). Overall 30-day mortality was 29 %. No statistically significant difference in the first laboratory values between the survivors and nonsurvivors was found. However, after excluding patients dying of head injuries (n = 5), a reasonable cut-off value was identified for the base excess (BE; lower than -10 mmol/l) obtained on admission. %26lt;br%26gt;Conclusions PRAF patients with exsanguinating bleeding from the large pelvic artery have the worst prognosis. Very low BE values (%26lt;- 10.0 mmol/l) on admission for exsanguinating patients have a negative predictive value for survival, thus anticipating a poor outcome in bleeding controlled with TAE only and an increased risk of death. In critical cases, an aggressive bleeding control protocol prompts extraperitoneal pelvic packing prior to TAE. PRAF-related rupture of the external iliac artery is rare and indicates surgical techniques in controlling and restoring blood supply to the lower leg.

• 出版日期2013-2