Jagteshwar Sandhu1,2, Robert Abrahams3, Zoe Miller4, Shivank Bhatia4, Tanya L Zakrison5, Prasoon Mohan4. 1. University of Miami Miller School of Medicine, Miami, FL, USA. Jagteshwarsandhu@gmail.com. 2. University of Miami Hospitals and Clinics, 1475 NW 12th Ave. Suite 1066-V, Miami, FL, 33136, USA. Jagteshwarsandhu@gmail.com. 3. Diagnostic and Interventional Radiology, Haywood Medical Imaging, Clyde, NC, USA. 4. Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA. 5. Department of Surgery, Jackson Memorial Hospital, Miami, FL, USA.
Abstract
OBJECTIVES: (1) To identify the factors predicting arterial extravasation in pelvic trauma and (2) to assess the efficacy of preperitoneal pelvic packing (PPP) in controlling arterial hemorrhage. METHODS: Institutional review board approved the retrospective study of 139 consecutive pelvic trauma patients who underwent angiographic intervention with or without prior PPP between January 2011 and December 2016. Patient demographics and presenting characteristics were recorded. Both groups of patients were combined for analysis of predictors for arterial extravasation using univariate logistic regression followed by multivariate logistic regression. Significance level was defined as p < 0.05. RESULTS: Forty-nine out of 139 patients had PPP prior to pelvic angiogram. Embolization was performed in 85 (61.2%) patients and the technical and clinical success rate was 100%. Sixty-nine (49.7%) patients had unstable Young-Burgess (Y&B) type fractures, of which 58% had arterial hemorrhage compared with 38.6% of those with stable Y&B fractures (p = 0.02). Of the patients who had PPP prior to angiogram, 28(57.1%) continued to have arterial extravasation on subsequent angiography. Unstable Y&B type fractures are independent predictors of arterial hemorrhage (OR 2.3, 95%CI 1.1 to 4.7, p = 0.02). CONCLUSION: Unstable Y&B type pelvic fractures are predictors of arterial extravasation. PPP alone is not effective for arterial hemorrhage control in pelvic trauma. Angiographic intervention remains a minimally invasive and definitive treatment of arterial hemorrhage from pelvic trauma. KEY POINTS: • Unstable Young-Burgess pelvic fractures are predictors of arterial hemorrhage in pelvic trauma. • Pelvic angiography and embolization should precede PPP wherever feasible.
OBJECTIVES: (1) To identify the factors predicting arterial extravasation in pelvic trauma and (2) to assess the efficacy of preperitoneal pelvic packing (PPP) in controlling arterial hemorrhage. METHODS: Institutional review board approved the retrospective study of 139 consecutive pelvic traumapatients who underwent angiographic intervention with or without prior PPP between January 2011 and December 2016. Patient demographics and presenting characteristics were recorded. Both groups of patients were combined for analysis of predictors for arterial extravasation using univariate logistic regression followed by multivariate logistic regression. Significance level was defined as p < 0.05. RESULTS: Forty-nine out of 139 patients had PPP prior to pelvic angiogram. Embolization was performed in 85 (61.2%) patients and the technical and clinical success rate was 100%. Sixty-nine (49.7%) patients had unstable Young-Burgess (Y&B) type fractures, of which 58% had arterial hemorrhage compared with 38.6% of those with stable Y&B fractures (p = 0.02). Of the patients who had PPP prior to angiogram, 28(57.1%) continued to have arterial extravasation on subsequent angiography. Unstable Y&B type fractures are independent predictors of arterial hemorrhage (OR 2.3, 95%CI 1.1 to 4.7, p = 0.02). CONCLUSION: Unstable Y&B type pelvic fractures are predictors of arterial extravasation. PPP alone is not effective for arterial hemorrhage control in pelvic trauma. Angiographic intervention remains a minimally invasive and definitive treatment of arterial hemorrhage from pelvic trauma. KEY POINTS: • Unstable Young-Burgess pelvic fractures are predictors of arterial hemorrhage in pelvic trauma. • Pelvic angiography and embolization should precede PPP wherever feasible.
Authors: Daniel C Cullinane; Henry J Schiller; Martin D Zielinski; Jaroslaw W Bilaniuk; Bryan R Collier; John Como; Michelle Holevar; Enrique A Sabater; S Andrew Sems; W Matthew Vassy; Julie L Wynne Journal: J Trauma Date: 2011-12