The role of interventional angiography and embolisation in the management of high-energy pelvic ring injuries with uncontrolled haemorrhage

BACKGROUND: The availability of and advances in interventional angiography and embolisation for the management of high-energy pelvic ring injuries with uncontrolled haemorrhage have expanded considerably during the last decade. Its routine use, however, still remains controversial. The delay in performing angiography is often cited as a major limitation for this intervention.  PURPOSE OF THE STUDY: We aim to determine the mean time to interventional angiography and embolisation and report on the success rate thereof in patients with pelvic ring injuries and associated haemorrhage in a Level 1 Trauma Unit.  METHODOLOGY: Between 1997 and 2012, we identified a total of seven patients who were managed with interventional angiography for the treatment of pelvic ring injuries associated with massive haemorrhage that did not respond to fluids and blood products resuscitation alone. Data was collected retrospectively, with respect to the injury pattern, resuscitative parameters, survival rates and efficacy of the angiography.  RESULTS: All seven patients presented with high energy injuries and had rotationally as well as vertically unstable pelvic fractures. The average systolic blood pressure on admission was 80 mmHg (range 60-140). On average 8.75 (range 2-21) units of packed red blood cells were transfused per patient. Three patients required a laparotomy for associated intra-abdominal injuries. The time from admission to an emergency laparotomy was 4.5 h (range 2-12). The time from admission to angiography was 14 h (range 4-24). Three of the seven patients had a successful pelvic angio-embolisation. Six patients survived until discharge and one patient demised due to multi-organ failure on day 14 after embolisation.  DISCUSSION: Only seven patients with pelvic ring injuries were managed with angiography and embolisation in a period of 15 years, suggesting that we seldom use this modality for haemorrhage control. The delay from admission to angiography was 14 hours (range 4-24). An arterial bleed was successfully identified and embolised in three patients (43%).  CONCLUSION: While it is used with greater frequency in other centres, in our hospital setting angiography in the management of haemorrhage in pelvic ring injuries is rarely used. Our success rate with this intervention is fair.