Novel Transcatheter Arterial Embolization Method for Hemodynamically Unstable Pelvic Fractures to Prevent Complications of Gluteal Necrosis

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2019 Jan 10

PMID 30623196

Citations 4

Authors

Takaaki Maruhashi

Fumie Kashimi

Rika Kotoh

Shun Kasahara

Hiroaki Minehara

Yuichi Kataoka

Hiroshi Nishimaki

Yasushi Asari

Affiliations

Soon will be listed here.

Abstract

Purpose: To validate our previously designed transcatheter arterial embolization (TAE) technique for bilateral iliac arteries in unstable pelvic fractures, which is designed to also prevent gluteal necrosis and avoid vasopressors.

Methods: We retrospectively analyzed the data of patients with pelvic fractures who underwent our new TAE procedure to determine the incidence of subsequent gluteal necrosis. We also compared certain variables between patients who underwent TAE before 2005 using a different technique and developed gluteal necrosis and patients who underwent TAE in 2005 and onward using our technique. Gluteal necrosis was confirmed by a radiologist based on imaging findings.

Results: Seventy patients with pelvic fractures who underwent our TAE technique met the inclusion criteria (bilateral iliac arterial embolization and no embolic agent other than a gelatin sponge). Patients' median age was 47.5 years, 33 were male, and 92.9% (65/70) had unstable fractures. Sixty-eight patients had severe multiple trauma. No patients developed gluteal necrosis following our TAE procedure and the overall survival rate was 82.9% (58/70). We found no statistically significant difference in procedure time between the previous and new technique, although the new procedure tended to be shorter. Furthermore, overall survival did not significantly differ between the groups. Multiple regression analysis revealed that TAE procedure time and external pelvic fracture fixation were independently related to gluteal necrosis.

Conclusions: Our non-selective bilateral iliac arterial embolization procedure involves arresting shock quickly, resulting in no post-procedure gluteal necrosis. The procedure involves cutting the gelatin sponge rather than "pumping" and avoids the use of vasopressors.

Citing Articles

Transcatheter Arterial Embolization for Hemorrhagic Pelvic Fracture: Review Article.

Usui R, Kondo H Interv Radiol (Higashimatsuyama). 2024; 9(3):156-163.

PMID: 39559807 PMC: 11570184. DOI: 10.22575/interventionalradiology.2023-0015.

Nonselective versus Selective Angioembolization for Trauma Patients with Pelvic Injuries Accompanied by Hemorrhage: A Meta-Analysis.

Jang H, Jeong S, Park Y, Kang W Medicina (Kaunas). 2023; 59(8).

PMID: 37629782 PMC: 10456831. DOI: 10.3390/medicina59081492.

Efficacy of median sacral artery embolization for treating severe pelvic fractures: a retrospective study.

Maruhashi T, Kurihara Y, Oi M, Kashimi F, Tamura S, Kim M J Int Med Res. 2021; 49(12):3000605211063315.

PMID: 34878941 PMC: 8664313. DOI: 10.1177/03000605211063315.

Endovascular Management of Pelvic Trauma.

Khudari H, Aal A Semin Intervent Radiol. 2021; 38(1):123-130.

PMID: 33883809 PMC: 8049761. DOI: 10.1055/s-0041-1725112.

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