E4520. Pelvic Trauma: Diagnosis, Management, and Technical Approaches to Endovascular Therapy
Authors
Kristy Patel;
Rowan-Virtua, School of Osteopathic Medicine; University of Alabama at Birmingham
Alyssa Knight;
University of Alabama at Birmingham
Kasey Helmlinger;
University of Alabama at Birmingham
Husameddin El Khudari;
University of Alabama at Birmingham
Aliaksei Salei;
University of Alabama at Birmingham
Junaid Raja;
University of Alabama at Birmingham
Andrew Gunn;
University of Alabama at Birmingham
Background
Pelvic trauma has the potential to be life-threatening, with mortality rates reaching as high as 50%. TAE is preferred for both hemodynamically stable and unstable patients that require intervention to manage bleeding with minimal adverse outcomes. As such, TAE is a well-accepted treatment for pelvic trauma by the Western Trauma Association (WTA), World Society of Emergency Surgery (WSES), and Eastern Association for the Surgery of Trauma (EAST).
Educational Goals / Teaching Points
Diagnose and classify pelvic trauma through a case-based review of radiograph and CT findings. Review available management strategies for pelvic trauma, including observation, transarterial embolization (TAE), and surgery. Discuss approaches to patient selection for TAE. Understand technical considerations of TAE in pelvic trauma in a case-based format.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pelvic radiographs and CT are the most common diagnostic tests when evaluating a patient with suspected pelvic trauma. According to guidelines from the WSES, moderate pelvic injuries (hemodynamically stable) include Grade II (anteroposterior and lateral compression) and Grade III (vertical shear and combined mechanism trauma), and severe pelvic injuries are classified as Grade IV (hemodynamically unstable, independent from mechanical status) injuries. Regarding management, societal guidelines generally separate patients based on their hemodynamic stability. Hemodynamically stable patients with low grade pelvic injuries can be managed nonoperatively with binders or packing; and those with moderate to high-grade pelvic injuries should be referred for angiography. Hemodynamically unstable patients with extensive pelvic injury can require surgical exploration. TAE for pelvic trauma results in high rates of clinical success with an overall low rate of major complications. A variety of embolic agents, including gelatin sponge slurry, particles, coils, and liquid embolics can be successfully used.
Conclusion
Interventional radiologists play a significant and growing role for patients with traumatic pelvic injuries.
