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Angiographic Embolization for Pelvic Fractures in Older Patients
Brian J. Kimbrell, MD;
George C. Velmahos, MD;
Linda S. Chan, PhD;
Demetrios Demetriades, MD, PhD
Arch Surg. 2004;139:728-733.
Hypothesis Old age predicts reliably the presence of pelvic bleeding, requiring angiographic embolization (AE) among blunt trauma patients with major pelvic fractures.
Design Four-year prospective observational study (April 1, 1999, to May 31, 2003).
Setting Academic level I trauma center practicing AE liberally.
Patients Regardless of hemodynamic stability or the absence of a blood transfusion, patients with major pelvic fractures or significant pelvic hematomas on computed tomography were offered pelvic angiography with the intent to embolize.
Main Outcome Measure Angiographically confirmed pelvic bleeding, resulting in AE.
Results Of 92 patients who underwent pelvic angiography, 55 (60%) had bleeding found on angiography and underwent AE. Patients 60 years and older had a higher likelihood than younger patients to have bleeding identified and to undergo AE (16 [94%] of 17 patients vs 39 [52%] of 75 patients; P<.001). An age of 60 years or older was the only independent predictor of the need for AE. Of patients in this age group, two thirds had normal vital signs on hospital admission. Bleeding was controlled by AE in all patients (100% efficacy).
Conclusions Among blunt trauma patients with significant pelvic fractures, those 60 years and older have a high likelihood of active retroperitoneal bleeding. Angiographic embolization should be offered liberally to patients in this age group, regardless of presumed hemodynamic stability.
From the Division of Trauma and Surgical Critical Care, the Department of Surgery (Drs Kimbrell, Velmahos, and Demetriades), and the Department of Biostatistics (Dr Chan), University of Southern California and the Los Angeles County and University of Southern California Medical Center, Los Angeles, Calif.
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