Does Pelvic Angioembolization Increase Pelvic Ischemic Complications? A Multicenter American Association for the Surgery of Trauma Study.

Abstract

Controversy exists about whether pelvic angioembolization (PAE) causes ischemic complications of the pelvis and whether selective vs nonselective embolization influences the risk of these complications. We conducted a multicenter prospective observational study of adult blunt trauma patients with pelvic fractures who underwent angiography for 55 months. Patients who underwent angiography were divided into 4 groups: no embolization (No-Embo), selective embolization (Sel), unilateral nonselective embolization (Non-Sel), and bilateral Non-Sel embolization (B-Non-Sel). The primary outcome was ischemic complications, defined as gluteal skin and muscle necrosis, pelvic abscess, pelvic wound infection, pelvic wound breakdown, and osteomyelitis of the pelvis or femoral head. Of the 460 patients undergoing angiography, pelvic ischemic complications occurred in 45 patients (9.8%). Of these 45 patients, 4 were in the No-Embo group (5.1%), 24 (10.0%) in the Sel group, 11 (15.1%) in the Non-Sel group, and 6 (8.8%) in the B-Non-Sel. There was no significant difference when comparing the groups on univariate analysis (p = 0.23), multivariable analysis (Sel odds ratio [OR] = 2.16, p = 0.3; Non-Sel OR = 4.17, p = 0.07; B-Non-Sel OR = 1.00, p = 0.99) nor when comparing each complication individually. The current study is the largest to date of blunt pelvic fracture patients undergoing angiography. On comparing those not embolized with those selectively and nonselectively embolized, we found no association between pelvic angioembolization and pelvic ischemic complications. The decision of when and where to embolize should be individualized to the injury encountered and the stability of the patient.