Sherman Nathan C, Williams Keneeshia N, Hennemeyer Charles T, Devis Paola, Chehab Mohamad, Joseph Bellal, Tang Andrew L
From the Department of Orthopaedic Surgery (N.C.S.), University of Arizona, Tucson, AZ; Department of Surgery (K.N.W.), Emory University, Atlanta, GA; Department of Medical Imaging (C.T.H.), University of Arizona, Tucson, AZ; Interventional Radiology (P.D.), Southern Arizona VA Healthcare System, Tucson, AZ; and Department of Surgery (M.C., B.J., A.L.T.), University of Arizona, Tucson, AZ.
J Trauma Acute Care Surg. 2021 Aug 1;91(2):318-324. doi: 10.1097/TA.0000000000003190.
Pelvic angioembolization (AE) is a mainstay in the treatment algorithm for pelvic hemorrhage from pelvic fractures. Nonselective AE refers to embolization of the bilateral internal iliac arteries (IIAs) proximally rather than embolization of their tributaries distally. The aim of this study was to quantify the effect of nonselective pelvic AE on pelvic venous flow in a swine model. We hypothesized that internal iliac vein (IIV) flow following IIA AE is reduced by half.
Nine Yorkshire swine underwent nonselective right IIA gelfoam AE, followed by left. Pelvic arterial and venous diameter, velocity, and flow were recorded at baseline, after right IIA AE and after left IIA AE. Linear mixed-effect model and signed rank test were used to evaluate significant changes between the three time points.
Eight swine (77.8 ± 7.1 kg) underwent successful nonselective IIA AE based on achieving arterial resistive index of 1.0. One case was aborted because of technical difficulties. Compared with baseline, right IIV flow rate dropped by 36% ± 29% (p < 0.05) and 54% ± 29% (p < 0.01) following right and left IIA AE, respectively. Right IIA AE had no initial effect on left IIV flow (0.37% ± 99%, p = 0.95). However, after left IIA AE, left IIV flow reduced by 54% ± 27% (p < 0.01). Internal iliac artery AE had no effect on the external iliac arterial or venous flow rates and no effect on inferior vena cava flow rate.
The effect of unilateral and bilateral IIA AE on IIV flow appears to be additive. Despite bilateral IIA AE, pelvic venous flow is diminished but not absent. There is abundant collateral circulation between the external and internal iliac vascular systems. Arterial embolization may reduce venous flow and improve on resuscitation efforts in those with unstable pelvic fractures.
Prognostic, level IV.
盆腔血管栓塞术（AE）是骨盆骨折所致盆腔出血治疗方案中的主要手段。非选择性AE是指在近端栓塞双侧髂内动脉（IIA），而非在远端栓塞其分支。本研究的目的是在猪模型中量化非选择性盆腔AE对盆腔静脉血流的影响。我们假设IIA AE后髂内静脉（IIV）血流减少一半。
9只约克夏猪先接受右侧IIA明胶海绵非选择性AE，随后接受左侧AE。在基线、右侧IIA AE后和左侧IIA AE后记录盆腔动脉和静脉的直径、速度及血流。采用线性混合效应模型和符号秩检验评估三个时间点之间的显著变化。
8只猪（77.8±7.1 kg）基于动脉阻力指数达到1.0成功接受了非选择性IIA AE。1例因技术困难中止。与基线相比，右侧和左侧IIA AE后，右侧IIV流速分别下降36%±29%（p<0.05）和54%±29%（p<0.01）。右侧IIA AE对左侧IIV血流无初始影响（0.37%±99%，p=0.95）。然而，左侧IIA AE后，左侧IIV血流减少54%±27%（p<0.01）。髂内动脉AE对外髂动脉或静脉流速无影响，对下腔静脉流速也无影响。
单侧和双侧IIA AE对IIV血流的影响似乎是累加的。尽管进行了双侧IIA AE，盆腔静脉血流减少但未消失。髂外和髂内血管系统之间有丰富的侧支循环。动脉栓塞可能减少静脉血流，并改善不稳定骨盆骨折患者的复苏效果。
预后性研究，IV级。
