Comai Alessio, Zatelli Marianna, Haglmuller Thomas, Bonatti Giampietro
Department of Radiology, Hospital of Bolzano.
Department of Anesthesiology, Hospital of Bolzano.
Cureus. 2016 Aug 3;8(8):e722. doi: 10.7759/cureus.722.
The most common life-threatening complication of pelvic trauma is bleeding. Arterial bleedings frequently require active management, preferably with transcatheter arterial embolization (TAE). Hemodynamic instability and/or contrast extravasation at computer tomography (CT) examination are reliable indicators of arterial injury. Unstable pelvic fractures are much more hemorrhagic than stable fractures. Nevertheless, an absent or isolated pelvic fracture does not exclude pelvic hemorrhage.
A retrospective study was conducted on our institutional database by collecting data of patients who underwent pelvic angiography and/or embolization due to pelvic blunt trauma in the period between August 2010 and August 2015.
In a period of five years, 39 patients with traumatic pelvic bleeding underwent angiography at our institution. Thirty-six of the 39 (92%) patients did show CT signs of active pelvic bleeding. Nineteen of 39 (49%) patients were hemodynamically unstable at presentation. Three of the 39 patients did not require embolization. Technical success was 35/36 (97%), and overall mortality was 3/39 (8%). Notably, 5/39 (13%) patients did not have any pelvic fracture at presentation, and 18/39 (46%) had only isolated or stable pelvic ring fracture.
TAE is an effective technique to treat arterial pelvic bleeding after trauma. The absence of a major pelvic fracture does not exclude the risk of active bleeding requiring prompt treatment.
骨盆创伤最常见的危及生命的并发症是出血。动脉出血常常需要积极处理，最好采用经导管动脉栓塞术（TAE）。计算机断层扫描（CT）检查时的血流动力学不稳定和/或造影剂外渗是动脉损伤的可靠指标。不稳定骨盆骨折的出血比稳定骨折多得多。然而，没有骨盆骨折或仅有孤立的骨盆骨折并不能排除骨盆出血。
对我院机构数据库进行回顾性研究，收集2010年8月至2015年8月期间因骨盆钝性创伤接受骨盆血管造影和/或栓塞治疗的患者数据。
在五年期间，我院有39例创伤性骨盆出血患者接受了血管造影。39例患者中有36例（92%）显示出骨盆活动性出血的CT征象。39例患者中有19例（49%）就诊时血流动力学不稳定。39例患者中有3例不需要栓塞治疗。技术成功率为35/3（97%），总死亡率为3/39（8%）。值得注意的是，39例患者中有5例（13%）就诊时没有任何骨盆骨折，18例（46%）仅有孤立的或稳定的骨盆环骨折。
TAE是治疗创伤后骨盆动脉出血的有效技术。没有严重骨盆骨折并不排除存在需要及时治疗的活动性出血风险。
