J Korean Soc Radiol.  2016 Apr;74(4):236-244. 10.3348/jksr.2016.74.4.236.

Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

• Park JY
• Yim NY
• Kim JK
• Kim HO
• Kang YJ
• Jung HD
• Kim SK
• Yoon W

• KMID: 2208781
• DOI: http://doi.org/10.3348/jksr.2016.74.4.236

Abstract

PURPOSE
To determine the efficacy of embolization with super-selective catheterization of the internal iliac arterial branches to treat heavily injured trauma patients with pelvic arterial bleeding.
MATERIALS AND METHODS
A retrospective analysis was performed using the medical records of 37 patients who underwent trans-arterial embolization for trauma-associated pelvic arterial hemorrhage in a regional trauma center between July 2010 and July 2013. In each patient, hemodynamic stability, embolization level, elapsed time for trans-arterial embolization, clinical outcome and embolization-related complications were evaluated. Comparison of elapsed time, and presence of complication was done according to embolization level.
RESULTS
Transarterial embolization was conducted in 37 patients. Hemodynamic stability of each patient was classified into hemodynamic stable (n = 9), and unstable (n = 28). Twenty-nine of 37 patients underwent embolization after super-selective catheterization of more than 2nd order branch of internal iliac artery with a microcatheter, and 8 patients underwent proximal internal iliac artery embolization without super-selective catheterization. The mean elapsed procedure time for super-selective embolization (34.76 ± 20.0 minutes) was not significantly longer than proximal internal iliac artery embolization (33.87 ± 16.73 minutes, p = 0.215).
CONCLUSION
Pelvic arterial embolization with super-selective catheterization is a safe and feasible treatment for heavily injured patients with trauma-associated pelvic arterial bleeding.

MeSH Terms

Catheterization*
Catheters*
Embolization, Therapeutic
Hemodynamics
Hemorrhage*
Humans
Iliac Artery
Medical Records
Pelvic Bones
Retrospective Studies
Trauma Centers
Wounds and Injuries

Figure

• 

  Fig. 1 Embolization after super-selective catheterization. A 61-year-old woman (case no. 20) treated with embolization of the right internal pudendal artery presented with unstable hemodynamics (hemodynamic instability score = 4). A. Axial contrast-enhanced computed tomography shows extravasation around the right side of the pelvic wall (arrow). B, C. Angiography shows active bleeding from the small branch of the internal pudendal artery. The microcatheter is introduced into the internal pudendal artery (arrowheads). D. Angiogram after coil embolization shows complete exclusion of bleeding.

• 

  Fig. 2 Embolization without super-selective catheterization. A 73-year-old woman (case no. 24) treated with embolization of the bilateral proximal internal iliac artery using gelfoam slurry presented with unstable hemodynamics (hemodynamic instability score = 4). A. Initial pelvic angiography shows multifocal hemorrhages from the bilateral internal iliac artery branches (arrows). B. Angiogram obtained after embolization of the proximal internal iliac artery shows complete exclusion of bleeding site. This patient did not survive after embolization due to complications from a combined hypoxic brain injury.

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