Pelvic Angiography for Trauma in Children: A Rare but Useful Adjunct.

Pelvic angiography with embolization can successfully control hemorrhage in adults with pelvic fractures. However, evidence to support similar application in children is sparse. We describe our experience using angiography for pediatric pelvic fractures to further highlight the safety and efficacy of this treatment approach.  A retrospective review at a pediatric tertiary care center was performed from 2004 to 2014. Inpatients treated for a pelvic fracture were considered.  A total of 216 patients were analyzed. Four patients (1.9%) underwent pelvic angiography. Three of these patients had active contrast extravasation on angiography and underwent successful embolization. All patients who underwent angiography showed computed tomography (CT) or clinical evidence of ongoing hemorrhage. No surgical intervention was needed after angiography. No complications of angiography occurred. Three patients who were found to have active extravasation on CT did not require angiography and were stabilized in the intensive care unit; two patients went on to have delayed operative repair. Mortality was 2.3%. All deaths were secondary to concomitant traumatic brain injury. No mortality occurred in patients undergoing pelvic angiography or those with pelvic contrast extravasation on CT.  Pelvic angiography is a useful treatment option in pediatric patients with pelvic fractures and clinical evidence of ongoing blood loss without other explanation. Contrast extravasation on CT scan alone may not require further intervention.