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  • Title: Anterior-posterior compression pelvic fracture increases the probability of requirement of bilateral embolization.
    Author: Fu CY, Hsieh CH, Wu SC, Chen RJ, Wang YC, Shih CH, Huang HC, Huang JC, Tsuo HC, Tung HJ.
    Journal: Am J Emerg Med; 2013 Jan; 31(1):42-9. PubMed ID: 22944536.
    Abstract:
    INTRODUCTION: Transarterial embolization has become an effective method in the management of pelvic fracture-related retroperitoneal hemorrhage. However, the selection of bilateral embolization or selective unilateral embolization remains controversial. The anterior-posterior compression (APC) pelvic fracture creates a complete diastasis of the anterior pelvis, which might be associated with bilateral sacroiliac joint injuries and further bilateral arterial injuries. In the current study, we evaluated the correlation between APC pelvic fracture and the need for bilateral internal iliac artery (IIA) embolization. METHODS: During the 78-month investigational period, patients who received either unilateral or bilateral IIA embolization over the injured site, as determined by angiographic findings, were enrolled. The patients with bilateral contrast extravasation (CE) revealed by angiography were compared with the patients with unilateral CE revealed by angiography. Among the patients with only unilateral positive findings (CE or hematoma formation) on computed tomographic scanning, the characteristics and risk factors of patients who required bilateral IIA embolization were analyzed. The patients with postembolization hemorrhage who had received repeat transarterial embolization were also identified and discussed. RESULTS: Seventy patients were enrolled in the current study. The rate of APC pelvic fracture among patients who received bilateral IIA embolization was 66.7% (18/27), which was significantly higher than the rate among patients who received unilateral IIA embolization (30.2%; 3/43) (P = .006). Of the patients with only unilateral positive findings on computed tomographic scanning, 21.6% (11/51) underwent bilateral IIA embolization because of bilateral CE revealed by angiography. There were also more patients with APC pelvic fracture in this group. CONCLUSION: In the management of APC pelvic fracture, more attention should be paid to the higher probability of bilateral hemorrhage. Bilateral IIA embolization should be considered in patients with APC pelvic fracture.
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