Bilateral internal iliac artery embolization for pelvic trauma: Effectiveness and safety - 20/06/20

Doi : 10.1016/j.amjsurg.2019.12.013

Alexander Bonde ^a,^b, Andriana Velmahos ^a, Sanjeeva P. Kalva ^c, April E. Mendoza ^a, Haytham M.A. Kaafarani ^a, Charlie J. Nederpelt ^a,^{^{1
Permanent address: Afdeling Heelkunde, Leids Universitair Medisch Centrum, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.c.j.nederpelt@lumc.nl},}^⁎
^a Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts, General Hospital, Harvard Medical School, Boston, United States
^b Department of Anesthesia, Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
^c Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical, School, Boston, United States

^∗Corresponding author. Division of Trauma, Emergency Surgery and Surgical Critical Care, Suite 810, 165 Cambridge Street, Boston, MA, 02114.Division of Trauma, Emergency Surgery and Surgical Critical CareSuite 810165 Cambridge StreetBostonMA02114

Abstract

Introduction

Bilateral internal iliac artery embolization (BIIAE) with temporary embolic materials epitomizes damage-control principles in the treatment of exsanguinating hemorrhage from pelvic trauma. However, instances of ischemic complications have been reported. The aim of our study was to assess safety and effectiveness of BIIAE.

Methods

All patients who received BIIAE for pelvic trauma at a Level I Trauma Center between 1998 and 2018 were reviewed. Effectiveness was assessed by radiographic bleeding control and clinical bleeding control, i.e. stabilization of vital signs and reduction in blood transfusion. Safety was assessed by any evidence for ischemic damage of pelvic organs or tissues.

Results

Of 61 patients undergoing BIIAE, bleeding control was confirmed radiographically in 60 (98%) and clinically in 55 (90%), including 4 (7%) patients who required repeat embolization. Six (10%) patients died due to insufficient pelvic bleeding control. No BIIAE-related complications were identified.

Conclusion

The overall clinical effectiveness and safety rates of BIIAE for pelvic bleeding control, when combined with other methods of hemostasis, were 90% and 100% respectively.

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Highlights

•	BIIAE, combined with other interventions, was associated with 90% clinical effectiveness.
•	No complications related to BIIAE were reported in our cohort.
•	BIIAE should be considered for life-threatening pelvic bleeding.

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Keywords : Pelvic trauma: angio-embolization, Damage control

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Vol 220 - N° 2

P. 454-458 - août 2020 Retour au numéro

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Bilateral internal iliac artery embolization for pelvic trauma: Effectiveness and safety - 20/06/20

Abstract

Introduction

Methods

Results

Conclusion

Highlights

Plan

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