Transcatheter Arterial Embolization for Bleeding Related to Pelvic Trauma: Comparison of Technical and Clinical Results Between Hemodynamically Stable and Unstable Patients

Overview

Journal Tomography

Publisher MDPI

Specialty Radiology

Date 2023 Sep 22

PMID 37736986

Authors

Roberto Minici

Michele Mercurio

Giuseppe Guzzardi

Massimo Venturini

Federico Fontana

Luca Brunese

Pasquale Guerriero

Raffaele Serra

Filippo Piacentino

Marco Spinetta

Lorenzo Zappia

Davide Costa

Andrea Coppola

Mgjr Research Team

Olimpio Galasso

Domenico Lagana

Affiliations

Soon will be listed here.

Abstract

Background: Endovascular intervention is now the primary line of therapy for arterial injury brought on by pelvic trauma since it can significantly reduce considerable morbidity associated with surgery and can swiftly access and control bleeding sites. Despite international guidelines and widespread awareness of the role of angioembolization in clinical practice, robust evidence comparing the outcomes of angioembolization in hemodynamically stable and unstable patients is still lacking. This study aims to directly compare the outcomes of angioembolization for the treatment of pelvic traumatic arterial injury in patients with hemodynamic stability vs. hemodynamic instability.

Methods: In our multicenter retrospective investigation, we analyzed data from consecutive patients who underwent, from January 2020 to May 2023, angioembolization for traumatic pelvic arterial injury.

Results: In total, 116 angioembolizations were performed. Gelatin sponges (56.9%) and coils (25.9%) were the most widely used embolic agents. The technical and clinical success rates were 100% and 91.4%, respectively. No statistically significant differences were observed between the two groups in terms of technical success, clinical success, procedure-related complication rate, or 30-day bleeding-related mortality.

Conclusions: Angioembolization is an effective and safe option for the management of traumatic pelvic arterial lesions even in hemodynamically unstable patients, despite technical variations such as greater use of prophylactic angioembolization.

Citing Articles

Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs).

Minici R, Guerriero P, Fontana F, Venturini M, Guzzardi G, Piacentino F Medicina (Kaunas). 2023; 59(9).

PMID: 37763725 PMC: 10537405. DOI: 10.3390/medicina59091606.

References

Yang X, Wang S, Zhang X, Ye C, Wang S, An X . Development of PVA-based microsphere as a potential embolization agent. Mater Sci Eng C Mater Biol Appl. 2022; 135:112677. DOI: 10.1016/j.msec.2022.112677. View

Abdulmalak G, Chevallier O, Falvo N, Di Marco L, Bertaut A, Moulin B . Safety and efficacy of transcatheter embolization with Glubran2 cyanoacrylate glue for acute arterial bleeding: a single-center experience with 104 patients. Abdom Radiol (NY). 2017; 43(3):723-733. DOI: 10.1007/s00261-017-1267-4. View

Shi Z, Yang J, Liang H, Cai Z, Bai B . Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage. Medicine (Baltimore). 2018; 96(52):e9437. PMC: 6392562. DOI: 10.1097/MD.0000000000009437. View

Velmahos G, Toutouzas K, Vassiliu P, Sarkisyan G, Chan L, Hanks S . A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma. 2002; 53(2):303-8; discussion 308. DOI: 10.1097/00005373-200208000-00019. View

Cullinane D, Schiller H, Zielinski M, Bilaniuk J, Collier B, Como J . Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture--update and systematic review. J Trauma. 2011; 71(6):1850-68. DOI: 10.1097/TA.0b013e31823dca9a. View

Aoki R, Nakajima K, Kobayashi Y, Sakai Y, Kamide H, Yamamoto T . Common and uncommon vascular injuries and endovascular treatment associated with pelvic blunt trauma: a real-world experience. Jpn J Radiol. 2022; 41(3):258-265. PMC: 9974705. DOI: 10.1007/s11604-022-01355-1. View

van der Vlies C, Saltzherr T, Reekers J, Ponsen K, van Delden O, Goslings J . Failure rate and complications of angiography and embolization for abdominal and pelvic trauma. J Trauma Acute Care Surg. 2012; 73(5):1208-12. DOI: 10.1097/TA.0b013e318265ca9f. View

Brun J, Guillot S, Bouzat P, Broux C, Thony F, Genty C . Detecting active pelvic arterial haemorrhage on admission following serious pelvic fracture in multiple trauma patients. Injury. 2013; 45(1):101-6. DOI: 10.1016/j.injury.2013.06.011. View

Minici R, Paone S, Talarico M, Zappia L, Abdalla K, Petulla M . Percutaneous treatment of vascular access-site complications: a ten years' experience in two centres. CVIR Endovasc. 2020; 3(1):29. PMC: 7276472. DOI: 10.1186/s42155-020-00120-7. View

10.

Vaidya S, Tozer K, Chen J . An overview of embolic agents. Semin Intervent Radiol. 2011; 25(3):204-15. PMC: 3036437. DOI: 10.1055/s-0028-1085930. View

11.

. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013; 74(5):1363-6. DOI: 10.1097/TA.0b013e31828b82f5. View

12.

Papakostidis C, Kanakaris N, Dimitriou R, Giannoudis P . The role of arterial embolization in controlling pelvic fracture haemorrhage: a systematic review of the literature. Eur J Radiol. 2011; 81(5):897-904. DOI: 10.1016/j.ejrad.2011.02.049. View

13.

Bokenkamp M, Dorken Gallastegi A, Brown T, Hwabejire J, Fawley J, Mendoza A . Angioembolization in Severe Pelvic Trauma is Associated with Venous Thromboembolism. J Surg Res. 2022; 283:540-549. DOI: 10.1016/j.jss.2022.10.054. View

14.

Minici R, Mercurio M, Ianno B, Galasso O, Gasparini G, Lagana D . Advantages of the Use of Axial Traction Magnetic Resonance Imaging (MRI) of the Shoulder in Patients with Suspected Rota-Tor Cuff Tears: An Exploratory Pilot Study. Healthcare (Basel). 2023; 11(5). PMC: 10000934. DOI: 10.3390/healthcare11050724. View

15.

Travis T, Monsky W, London J, Danielson M, Brock J, Wegelin J . Evaluation of short-term and long-term complications after emergent internal iliac artery embolization in patients with pelvic trauma. J Vasc Interv Radiol. 2008; 19(6):840-7. DOI: 10.1016/j.jvir.2008.02.011. View

16.

Fang J, Shih L, Wong Y, Lin B, Hsu Y . Repeat transcatheter arterial embolization for the management of pelvic arterial hemorrhage. J Trauma. 2009; 66(2):429-35. DOI: 10.1097/TA.0b013e31817c969b. View

17.

Padia S, Ingraham C, Moriarty J, Wilkins L, Bream Jr P, Tam A . Society of Interventional Radiology Position Statement on Endovascular Intervention for Trauma. J Vasc Interv Radiol. 2020; 31(3):363-369.e2. DOI: 10.1016/j.jvir.2019.11.012. View

18.

Sandhu J, Abrahams R, Miller Z, Bhatia S, Zakrison T, Mohan P . Pelvic Trauma: factors predicting arterial hemorrhage and the role of Angiography and preperitoneal pelvic packing. Eur Radiol. 2020; 30(11):6376-6383. DOI: 10.1007/s00330-020-06965-9. View

19.

Minici R, Ammendola M, Talarico M, Luposella M, Minici M, Ciranni S . Endovascular recanalization of chronic total occlusions of the native superficial femoral artery after failed femoropopliteal bypass in patients with critical limb ischemia. CVIR Endovasc. 2021; 4(1):68. PMC: 8423883. DOI: 10.1186/s42155-021-00256-0. View

20.

Coccolini F, Stahel P, Montori G, Biffl W, Horer T, Catena F . Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017; 12:5. PMC: 5241998. DOI: 10.1186/s13017-017-0117-6. View