Blunt pelvic trauma is commonly encountered in major trauma centers. Associated injuries are common but mortality related to pelvic fractures alone when associated with haemodynamic instability is not insignificant. Interventional radiology (IR) can provide rapid cessation of haemorrhage if considered early in patient management and there is a vast amount of evidence in support of IR in this setting. Early identification of patients who are likely to benefit from angiography and embolisation is of paramount importance and demands a multidisciplinary approach to provide the patient with the best chance of survival. This article reviews the evidence for IR in this setting and discusses the techniques available.
Abulaban O., Hopkins J., Willis AP et al. 2010. Pelvic arterial embolisation in a trauma patient with a preexisting aortobifemoral graft. Cardiovasc Intervent Radiol19: March (2010) [Epub ahead of print].
2.
Argolini SF, Shah K., Jaffe J.1997. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma43: 395-9.
3.
Ben-Menachem Y., Coldwell DM, Young JWR.1991. Haemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management. Am J Roentgenol157: 1005-14.
4.
Burgess AR, Eastridge BJ, Young JW et al. 1990. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma30: 848-56.
5.
Chait A., Moltz A., Nelson JH1968. The collateral arterial circulation in the pelvis: an angiographic study. Am J Roentgenol102: 392-400.
6.
Collins CD, Jackson JE1995. Clinics in interventional radiology: pelvic arterial embolization following hysterectomy and bilateral internal iliac artery ligation for intractable primary post partum haemorrhage. Clin Radiol50: 710-14.
7.
Cook R., Gillespie I., Keating J.2002. The role of angiography in the management of haemorrhage from major pelvic fractures. J Bone Joint Surg Br84: 178-82.
8.
Cothren CC, Osborn PM, Moore EE et al. 2007. Preperitonal packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma62: 834-42.
9.
Durkin A., Sagi HC, Durham R. et al. 2006. Contemporary management of pelvic fractures . Am J Surg192: 211-23.
10.
Ertel W., Keel M., Eid K. et al. 2001. Control of severe hemorrhage using C-clam and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma15: 468-74.
11.
Flint Jr LM, Brown A., Richardson JD et al. 1979. Definitive control of bleed from severe pelvic fractures. Ann Surg189: 709-16.
12.
Ger R., Condrea H., Streichen FM1969. Traumatic intrapelvic retroperitoneal hemorrhage. An experimental study. J Surg Res9: 31-4.
13.
Ghanayem, Wilber JH, Lieberman JM et al. 1995. The effect of laparotomy and external fixator stabilisation on pelvic volume in an unstable pelvic injury. J Trauma38: 396-400.
14.
Gourlay D., Hoffer E., Routt M. et al. 2005. Pelvic angiography for recurrent traumatic pelvic arterial hemorrhage. J Trauma59: 1168-73.
15.
Hawkins L., Pomerantz M., Eiseman B.1970. Laparotomy at the time of pelvic fracture. J Trauma10: 619-23.
16.
Huber-Wagner S., Lefering R., Qvick LM et al. 2009. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet373: 1455-61.
17.
Huittinen VM, Slatis P.1973. Post mortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery73: 454-62.
18.
Jeske H.-C, Larndorfer R., Krappinger D. et al. 2010. Management of hemorrhage in severe pelvic injuries. J Trauma68: 415-20.
19.
Kataoka Y., Maekawa K., Nishimaki H. et al. 2005. Iliac vein injuries in hemodynamically unstable patients with pelvic fracture caused by blunt trauma. J Trauma58: 704-8.
20.
Margolies MN, Ring EJ, Waltman AC et al. 1972. Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med287: 317-21.
21.
Martinelli T., Thony F., Declety P. et al. 2010. Intra-aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shock from pelvic fractures. J Trauma68: 942-8.
22.
McCoy GF, Johnstone RA, Kenright J.1989. Biomechanical aspects of pelvic and hip injuries in road traffic accidents. J Orthop Trauma3: 118-23.
23.
Miller WE1963. Massive hemorrhage in fractures of the pelvis. South Med J56: 933-8.
24.
Miller PR, Moore PS, Mansell E. et al. 2003. External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial haemorrhage . J Trauma54: 437-42.
25.
Nicholson AA2004. Vascular radiology in trauma. Cardiovasc Intervent Radiol27: 105-20.
26.
Osborn PM, Smith WR, Moore EE et al. 2009. Direct retroperitoneal pelvic packing versus pelvic angiography: a comparison of two management protocols for haemodynamically unstable pelvic fractures. Injury40: 54-60.
27.
Patterson FP, Morton KS1973. The cause of death in pelvic fractures. J Trauma13: 849-56.
28.
Peltier LF1965. Complications associated with fractures of the pelvis . J Bone Joint Surg Am47: 1060-9.
29.
Pereira SJ, O’Brien DP, Luchette FA et al. 2000. Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture. Surgery128: 678-85.
30.
Poole GV, Ward EF1994. Causes of mortality in patients with pelvic fractures . Orthopedics17: 691-6.
31.
Poole GV, Ward EF, Muakkassa FF et al. 1991. Pelvic fracture from major blunt trauma: outcome is determined by associated injuries. Ann Surg213: 532-8.
32.
Ramirez JI, Velmahos GC, Best CR et al. 2004. Male sexual function after bilateral internal iliac artery embolization for pelvic fractures. J Trauma56: 734-41.
33.
Shapiro M., McDonald AA, Knight D. et al. 2005. The role of repeat angiography in the management of pelvic fractures. J Trauma58: 227-31.
34.
Suzuki T., Smith W., Moore EE2009. Pelvic packing or angiography: competitive or complementary?Injury40: 343-53.
35.
Uyeda J., Anderson S., Kertesz J. et al. 2010. Pelvic CT angiography: application to blunt trauma using 64MDCT. Emerg Radiol17: 131-7.
36.
Velmahos GC, Chahwan S., Hanks SE et al. 2000. Angiographic embolisation of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis. Am Surg66: 858-62.
37.
Velmahos GC, Toutouzas KG, Vassiliu P. et al. 2002. A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma52: 303-8.
38.
Yasumura K., Ikegami K., Kamohara T. et al. 2005. High incidence of ischaemic necrosis of the gluteal muscle after transcatheter angiographic embolization for severe pelvic fracture. J Trauma58: 985-90.
