Pelvic angioembolization in trauma – Indications and outcomes

• Pelvic angioembolization controls hemorrhage in hemodynamically stable and unstable patients with pelvic fractures.
• Intervention is most effective when done promptly; 24-h access to angiography is essential.
• Patients intra-abdominal injury require laparotomy before embolization – algorithms with FAST or CT help direct therapy.

IntroductionPelvic stabilization with angioembolization (AE) is steadily supplanting operative management for the treatment of pelvic hemorrhage in trauma. We aimed to provide a brief review of the indications, effectiveness and complications associated with AE for pelvic injuries.MethodsWe conducted a literature search using the terms “trauma,” “angioembolization,” and “pelvis” limited to studies published in the English language. Abstracts and full text were manually reviewed to identify suitable articles.ResultsThe current brief review is based on content from articles published in the last 10 years related to pelvic AE for retroperitoneal hemorrhage after trauma.DiscussionPelvic injuries often require complex management because the high energy transfer causes concomitant injuries. Outcomes for hemodynamically unstable patients may be better with AE than with operative management.ConclusionPelvic AE is the most effective intervention for management of hemorrhage associated with pelvic fracture in both hemodynamically stable and unstable patients. It can be used as the primary definitive intervention or in conjunction with operative management in the setting of concomitant intra-abdominal injury.