Anterior-posterior compression pelvic fracture increases the probability of requirement of bilateral embolization

Chih Yuan Fu, Chi Hsun Hsieh, Shih Chi Wu, Ray Jade Chen, Yu-Chun Wang, Chun Han Shih, Hung Chang Huang, Jui Chien Huang, Hsun Chung Tsuo, Hsiu Jung Tung

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)42-49
Number of pages8
JournalAmerican Journal of Emergency Medicine
Volume31
Issue number1
DOIs
Publication statusPublished - Jan 2013

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Compression Fractures
Iliac Artery
Angiography
Hemorrhage
Sacroiliac Joint
Wounds and Injuries
Pelvis
Hematoma

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Anterior-posterior compression pelvic fracture increases the probability of requirement of bilateral embolization. / Fu, Chih Yuan; Hsieh, Chi Hsun; Wu, Shih Chi; Chen, Ray Jade; Wang, Yu-Chun; Shih, Chun Han; Huang, Hung Chang; Huang, Jui Chien; Tsuo, Hsun Chung; Tung, Hsiu Jung.

In: American Journal of Emergency Medicine, Vol. 31, No. 1, 01.2013, p. 42-49.

Research output: Contribution to journalArticle

Fu, Chih Yuan ; Hsieh, Chi Hsun ; Wu, Shih Chi ; Chen, Ray Jade ; Wang, Yu-Chun ; Shih, Chun Han ; Huang, Hung Chang ; Huang, Jui Chien ; Tsuo, Hsun Chung ; Tung, Hsiu Jung. / Anterior-posterior compression pelvic fracture increases the probability of requirement of bilateral embolization. In: American Journal of Emergency Medicine. 2013 ; Vol. 31, No. 1. pp. 42-49.
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title = "Anterior-posterior compression pelvic fracture increases the probability of requirement of bilateral embolization",
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.",
author = "Fu, {Chih Yuan} and Hsieh, {Chi Hsun} and Wu, {Shih Chi} and Chen, {Ray Jade} and Yu-Chun Wang and Shih, {Chun Han} and Huang, {Hung Chang} and Huang, {Jui Chien} and Tsuo, {Hsun Chung} and Tung, {Hsiu Jung}",
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AU - Hsieh, Chi Hsun

AU - Wu, Shih Chi

AU - Chen, Ray Jade

AU - Wang, Yu-Chun

AU - Shih, Chun Han

AU - Huang, Hung Chang

AU - Huang, Jui Chien

AU - Tsuo, Hsun Chung

AU - Tung, Hsiu Jung

PY - 2013/1

Y1 - 2013/1

N2 - 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.

AB - 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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