Pelvic Artery Embolization Trends among Patients with Pelvic Fractures at a Level One Trauma Center
*Juan P. Cobar1, *Jeremy Fridling2, *Amir Ebadinejad1, Nishant Merchant1, *Monika Nelson1, Matthew Lissauer1, Jonathan Gates1, Jane Keating1
1. Department of Surgery, Hartford Hospital, Hartford, CT, United States. 2. Department of Surgery, University of Connecticut, Farmington, CT, United States.
Background Pelvic artery embolization (PAE) is an effective treatment for hemorrhage related to pelvic fractures. However, PAE may be associated with gluteal muscle necrosis, wound infections, and renal failure particularly when performed bilaterally. We sought to examine trends in decision-making among patients undergoing pelvic angiograms at our urban, level-one, academic trauma center. Study Design We conducted a single-center retrospective review of patients that underwent pelvic angiograms following trauma from 2018 ? 2022. Patients were classified according to presence and laterality of arterial hemorrhage on angiogram as well as embolization sites. Demographic information, comorbidities and injury patterns were also collected. Results We identified 83 patients who underwent pelvic angiograms following trauma during the study period. Mean age was 57.2 + 23.8 years, 65% were male and 77% white. The most common traumatic mechanism was motor vehicle collision and mean Injury Severity Score (ISS) was 25.5 + 14.4 points. On initial trauma CT, 59 (71.1%) had evidence of extravasation on at least one side of the pelvis. Interestingly, only 47 (56.6%) had bleeding detected on angiographic evaluation. Of these, 26 (57.4%) had right-sided hemorrhage, 12 (25.5%) had left-sided hemorrhage, and 9 (14.8%) presented with bilateral bleeding. All but one of the patients that received an angiogram received a PAE (98.8%). Of these patients, 46 (56.1%) underwent bilateral embolization and 36 (43.9%) underwent unilateral embolization. Finally, 29 (35%) patients received therapeutic embolization (PAE following positive angiogram) while 53 (64.6%) had empiric embolization (PAE following negative angiogram). When analyzing the trend in bilateral versus unilateral embolization, we consistently observed a preference for bilateral embolization regardless of presence of contrast extravasation on angiographic evaluation. Conclusion In the management of trauma involving pelvic hemorrhage, bilateral pelvic arterial embolization remains common at our institution. A future study will examine practice patterns following the recent initiation of guidelines suggesting therapeutic (and unilateral) PAE when clinically feasible.
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