Fri., 10/17/08 Pelvis/Injury Prevention, Paper #25, 11:14 am OTA-2008
Incidence of Acute Complications in Patients Who Were Treated with Angiography for Pelvic Bleeding Associated with Pelvic Fractures
Amir Matityahu, MD (a-Medtronik, Smith + Nephew, Stryker; a,b-AO, Synthes, Zimmer;
a,b,e-DePuy, A Johnson & Johnson Company); Corey Lieber, MD (n); Gregory Rogalski, MD (n);
Utku Kandemir, MD (a-AONA, SFGH Foundation); Cindy Lin, MPH (n); Tigist Belaye, MS (n);
Theodore Miclau, III, MD (n);
Department of Orthopaedic Surgery, San Francisco General Hospital, University of California,
San Francisco School of Medicine, San Francisco, California, USA
Introduction: In the hemodynamically unstable patient with pelvis fractures and arterial pelvic bleeding, angiography may be the treatment of choice. Angiographic embolization is purported to be a relatively simple, safe, rapid and effective method of controlling the hemorrhage. However, loss of blood supply may cause necrosis of tissues and organs that in turn may lead to functional deficits. The purpose of this study is to assess the incidence of acute complications during the first 6 months after surgery in patients who had pelvic fractures and were treated with pelvic arterial embolization for arterial bleeding.
Methods: We retrospectively reviewed the medical records of trauma patients at San Francisco General Hospital admitted between June 1999 and June 2007 who had a pelvic fracture and were treated with pelvic embolization. There were 909 patients with pelvic fractures out of 11,783 patients admitted to the trauma service. Angiography was performed on 155 patients and 88 were embolized. The mortality rate of patients who were sent to angiography was 20%. The average ISS was 32 for patients who were embolized and 35 for patients who had complications postembolization.
Results: There were 88 patients (49 male, 39 female) with a mean age of 48 years (range, 21- 85). Patient follow-up was at least 6 months. There were 18 acute complications (20%) in 12 patients (14%). Five of the patients with acute complications had open pelvic fractures. All of the patients with complications were treated with bilateral internal iliac arterial gel-foam embolization. Five patients had associated Morel-Lavallee lesions (6%). Five patients had gluteal muscle necrosis (6%). Seven patients had surgical incision wound breakdown (8%). Two patients developed impotence (2%), and one patient had bladder necrosis (1%).
Conclusion and Significance: Acute complications in our population of patients with pelvic fractures who had embolization of both internal iliac arteries were frequent (20%). Gluteal muscle necrosis was the most common complication. The most common perioperative clinical finding was a subcutaneous shearing injury that was most likely caused by direct force applied to the pelvis at time of injury. This complication rate may or may not be attributable to nonselective bilateral embolization of vessels, such as the internal iliac artery, which provide a redundant blood supply to the end organs. These patients need careful monitoring and aggressive treatment.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.