Download PDF
Semin intervent Radiol 2004; 21(1): 23-35
DOI: 10.1055/s-2004-831402
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Transcatheter Embolization in Pelvic Trauma

Scott R. Broadwell1 , Charles E. Ray1 , 2  Jr. 
  • 1Department of Diagnostic Radiology, University of Colorado Health Sciences Center, Denver, Colorado
  • 2Department of Interventional Radiology, Denver Health Medical Center, Denver, Colorado
Further Information

Publication History

Publication Date:
12 August 2004 (online)

Also available at
    Permissions and Reprints

This article outlines the clinical and radiological approach to patients with pelvic trauma. It reviews the clinical descriptions and classifications of pelvic trauma as well as the management of patients with stable and unstable fractures. A review of embolization techniques in these types of patients is provided.

KEYWORDS

Embolization - trauma - fractures

REFERENCES

  • 1 Margolies M N, Ring E J, Waltman A C, Kerr W S, Baum S. Arteriography in the management of hemorrhage from pelvic fractures.  N Engl J Med. 1972;  287 317-321
    PubMedGoogle Scholar
  • 2 Flint L M, Brown A, Richardson J D, Polk H C. Definitive control of bleeding from severe pelvic fractures.  Ann Surg. 1979;  189 709-714
    CrossrefPubMedGoogle Scholar
  • 3 Kam J, Jackson H, Ben-Menachem Y. Vascular injuries in blunt pelvic trauma.  Radiol Clin North Am. 1981;  19 171-186
    PubMedGoogle Scholar
  • 4 Mucha P, Farnell M B. Analysis of pelvic fracture management.  J Trauma. 1984;  24 379-385
    PubMedGoogle Scholar
  • 5 Panetta T, Sclafani S J, Goldstein A S, Phillips T F, Shaftan G W. Percutaneous transcatheter embolization for massive bleeding from pelvic fractures.  J Trauma. 1985;  25 1021-1028
    PubMedGoogle Scholar
  • 6 Moreno C, Moore E E, Rosenberger A, Cleveland H C. Hemorrhage associated with major pelvic fracture: a multispecialty challenge.  J Trauma. 1986;  26 987-993
    CrossrefPubMedGoogle Scholar
  • 7 Ben-Menachem Y, Coldwell D M, Young J W, Burgess A R. Hemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management.  AJR Am J Roentgenol. 1991;  157 1005-1014
    PubMedGoogle Scholar
  • 8 Agolini S F, Shah K, Jagge J, Newcomb J, Rhodes M, Reed J F. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage.  J Trauma. 1997;  43 395-399
    CrossrefPubMedGoogle Scholar
  • 9 Velmahos G C, Chahwan S, Falabella A, Hanks S E, Demetriades D. Angiographic embolization for intraperitoneal and retroperitoneal injuries.  World J Surg. 2000;  24 539-545
    CrossrefPubMedGoogle Scholar
  • 10 Velmahos G C, Chahwan S, Hanks S E et al.. Angiographic embolization of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis.  Am Surg. 2000;  66 858-862
    PubMedGoogle Scholar
  • 11 Biffl W L, Smith W R, Moore E E et al.. Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures.  Ann Surg. 2001;  233 843-850
    CrossrefPubMedGoogle Scholar
  • 12 Cook R E, Keating J F, Gillespie I. The role of angiography in the management of haemorrhage from major fractures of the pelvis.  J Bone Joint Surg (Br). 2002;  84-B 178-182
    PubMedGoogle Scholar
  • 13 McCoy G F, Johnstone R A, Kenright J. Biomechanical aspects of pelvic and hip injuries in road traffic accidents.  J Orthop Trauma. 1989;  3 118-123
    PubMedGoogle Scholar
  • 14 Grimm M R, Vrahas M S, Thomas K A. Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum.  J Trauma. 1998;  44 454-459
    CrossrefPubMedGoogle Scholar
  • 15 Rothenberger D A, Fischer R P, Strate R G, Velasco R, Perry J F. The mortality associated with pelvic fractures.  Surgery. 1978;  84 356-359
    PubMedGoogle Scholar
  • 16 Evers B M, Cryer H M, Miller F B. Pelvic fractures: priorities in management.  Arch Surg. 1989;  124 422-424
    PubMedGoogle Scholar
  • 17 Poole G V, Ward E F, Muakkassa F F, Hsu H SH, Griswold J A, Rhodes R S. Pelvic fracture from major blunt trauma: outcome is determined by associated injuries.  Ann Surg. 1991;  213 532-538
    PubMedGoogle Scholar
  • 18 Gruen G S, Leit M E, Gruen R J, Peitzman A B. The acute management of hemodynamically unstable multiple trauma patients with pelvic ring fractures.  J Trauma. 1994;  36 706-711
    PubMedGoogle Scholar
  • 19 Poole G V, Ward E F. Causes of mortality in patients with pelvic fractures.  Orthopedics. 1994;  17 691-696
    PubMedGoogle Scholar
  • 20 Muir L, Boot D, Gorman D F, Teanby D N. The epidemiology of pelvic fractures in the Mersey Region.  Injury. 1996;  27 199-204
    CrossrefPubMedGoogle Scholar
  • 21 Jones A L, Powell J N, Kellam J F, McCormack R G, Dust W, Wimmer P. Trauma to the adult pelvis and hip.  Orthop Clin North Am. 1997;  28 345-350
    CrossrefPubMedGoogle Scholar
  • 22 Parreira J G, Cimbra R, Rasslan S, Oliveira A, Fregoneze M, Mercadante M. The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures.  Injury. 2000;  31 677-682
    CrossrefPubMedGoogle Scholar
  • 23 Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes.  J Am Coll Surg. 2002;  195 1-10
    CrossrefPubMedGoogle Scholar
  • 24 Eastridge B J, Burgess A R. Pedestrian pelvic fractures: 5-year experience of a major urban trauma center.  J Trauma. 1997;  42 695-700
    PubMedGoogle Scholar
  • 25 Gilliland M D, Ward R E, Barton R M, Miller P W, Duke J H. Factors affecting mortality in pelvic fractures.  J Trauma. 1982;  22 691-693
    CrossrefPubMedGoogle Scholar
  • 26 Adams J E, Davis G G, Heidepriem R W, Alonso J E, Alexander C B. Analysis of the incidence of pelvic trauma in fatal automobile accidents.  Am J Forensic Med. 2002;  23 132-136
    PubMedGoogle Scholar
  • 27 Reed R A, Teitelbaum G P, Katz M D, Pentecost M J. Early management of the trauma patient with pelvic fracture: a medical perspective.  Semin Interv Radiol. 1992;  9 1-3
    PubMedGoogle Scholar
  • 28 Baum S. Abrams’ Angiography: Vascular and Interventional Radiology, 4th ed. Philadelphia, PA; Lippincott Williams & Wilkens 1997: 1648-1650
    Google Scholar
  • 29 Young J W, Burgess A R, Brumback R J, Poka A. Pelvic fractures: value of plain radiography in early assessment and management.  Radiology. 1986;  160 445-451
    PubMedGoogle Scholar
  • 30 Moore K L. Clinically Oriented Anatomy, 3rd ed. Baltimore; Williams and Wilkins 1992: 243-252
    Google Scholar
  • 31 Tile M. Fractures of the Pelvis and Acetabulum. Baltimore; William and Wilkins 1984
    Google Scholar
  • 32 Young J W, Resnik C S. Fracture of the pelvis: current concepts of classification.  AJR Am J Roentgenol. 1990;  155 1169-1175
    PubMedGoogle Scholar
  • 33 Burgess A R, Eastridge B J, Young J W et al.. Pelvic ring disruptions: effective classification system and treatment protocols.  J Trauma. 1990;  30 848-856
    CrossrefPubMedGoogle Scholar
  • 34 Hamill J, Holden A, Paice R, Civil I. Pelvic fracture pattern predicts pelvic arterial haemorrhage.  Aust N Z J Surg. 2000;  70 338-343
    CrossrefPubMedGoogle Scholar
  • 35 Henry S M, Pollack A N, Jones A L, Boswell S, Scalea T M. Pelvic fracture in geriatric patients: a distinct clinical entity.  J Trauma. 2002;  53 15-20
    CrossrefPubMedGoogle Scholar
  • 36 Pereira S J, O’Brien D P, Luchette F A et al.. Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture.  Surgery. 2000;  128 678-685
    CrossrefPubMedGoogle Scholar
  • 37 Mattox K L, Bickell W, Pepe P E, Burch J, Feliciano D. Prospective MAST study in 911 patients.  J Trauma. 1989;  29 1104-1112
    PubMedGoogle Scholar
  • 38 Chang F C, Harrison P B, Beech R R, Helmer S D. PASG: does it help in the management of traumatic shock?.  J Trauma. 1995;  39 453-456
    PubMedGoogle Scholar
  • 39 Mackersie R C, Christensen J M, Lewis F R. The prehospital use of external counterpressure: does MAST make a difference?.  J Trauma. 1984;  24 882-888
    PubMedGoogle Scholar
  • 40 Schneider P A, Mitchell J M, Allison E J. The use of military antishock trousers in trauma: a reevaluation.  J Emerg Med. 1989;  7 497-500
    CrossrefPubMedGoogle Scholar
  • 41 Agnew S G. Hemodynamically unstable pelvic fractures.  Orthop Clin North Am. 1994;  25 715-721
    PubMedGoogle Scholar
  • 42 Sclafani S J, Becker J A. Traumatic presacral hemorrhage: angiographic diagnosis and therapy.  AJR Am J Roentgenol. 1982;  138 123-126
    PubMedGoogle Scholar
  • 43 Huittinen V M, Slatis P. Postmortem angiography and dissection of the hypogastric artery in pelvic fractures.  Surgery. 1973;  73 454-462
    PubMedGoogle Scholar
  • 44 Kadir S. Diagnostic Angiography, 2nd ed. Philadelphia; W.B. Saunders 1991: 98-100
    Google Scholar
  • 45 Ray C E, Waltman A C. General principles of embolization and chemoembolization. In: Bakal CW, Silberzweig JE, Cynamon J, et al, Vascular and Interventional Radiology: Principles and Practice. New York; Thieme 2002: 93-94
    Google Scholar
  • 46 Bauer J R, Ray Jr. C E. Transcatheter arterial embolization in the trauma patient: a review.  Semin Interv Radiol. 2004;  21 11-22
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Kidney D D. The endovascular approach to trauma. In: Dyet JF, Ettles DF, Nicholson AA, et al Textbook of Endovascular Procedures. Philadelphia; Churchill Livingstone 2000: 314
    Google Scholar
  • 48 Fattori R, Napoli G, Lovato L et al.. Indications for, timing of, and results of catheter-based treatment of traumatic injury to the aorta.  AJR Am J Roentgenol. 2002;  179 603-609
    PubMedGoogle Scholar
  • 49 Hoffer E K, Karmy-Jones R, Bloch R D et al.. Treatment of acute thoracic aortic injury with commercially available abdominal aortic stent-grafts.  J Vasc Interv Radiol. 2002;  13 1037-1041
    PubMedGoogle Scholar
  • 50 Ray C E, Biffl W L. Neurovascular interventions in the trauma patient.  Semin Interv Radiol. 2002;  19 377-387
    PubMedGoogle Scholar
  • 51 Duke B J, Ryu R K, Coldwell D M, Brega K E. Treatment of blunt injury to the carotid artery by using endovascular stents: an early experience.  J Neurosurg. 1997;  87 825-829
    CrossrefPubMedGoogle Scholar
  • 52 Perez J V, Hughes T M, Bowers K. Angiographic embolization in pelvic fracture.  Injury. 1998;  29 187-191
    CrossrefPubMedGoogle Scholar
  • 53 Rose S C, Moore E E. Emergency trauma angiography: accuracy, safety, and pitfalls.  AJR Am J Roentgenol. 1987;  148 1243-1246
    PubMedGoogle Scholar
  • 54 Hare W S, Holland C J. Paresis following internal iliac artery embolization.  Radiology. 1983;  146 47-51
    PubMedGoogle Scholar
  • 55 Vassiliu P, Sava J, Toutouzas K G, Velmahos G C. Is contrast as bad as we think? Renal function after angiographic embolization of injured patients.  J Am Coll Surg. 2002;  194 142-146
    PubMedGoogle Scholar

Charles E RayM.D. 

Denver Health Medical Center

777 Bannock Street, Mail Code 0024

Denver, CO, 80204

Email: cray@dhha.org

      >