Document Detail


Pelvic angiography for recurrent traumatic pelvic arterial hemorrhage.
MedLine Citation:
PMID:  16385296     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Angiography is the gold standard for the diagnosis and treatment of pelvic arterial hemorrhage associated with pelvic fractures. In most cases, a single angiogram with embolization is adequate to control pelvic arterial hemorrhage. However, a small subset of patients, require repeat pelvic angiogram to evaluate and treat recurrent hemorrhage. This study seeks to define this population and determine clinical predictors of recurrent hemorrhage. METHODS: We conducted a retrospective case control study comparing patients with traumatic pelvic fracture undergoing repeated pelvic angiogram versus a single angiogram between the years 1995 and 2000. Stepwise logistic regression was used to identify the independent predictors of recurrent hemorrhage. RESULTS: In the years studied, 556 patients underwent a pelvic angiogram to evaluate for pelvic arterial hemorrhage associated with pelvic fractures. Among these, 42 (7.5%) patients underwent a second angiogram for suspected recurrent hemorrhage. In comparison to the initial angiogram, the source of bleeding on the repeat angiogram occurred at a new bleeding site in 68%, at a previously embolized site in 18%, and both in 14%. Significant risk factors for recurrent pelvic arterial hemorrhage included hypotension or transfusion of >2 U of blood per hour before the initial angiogram, pubic symphysis widening, and more than two injured arteries requiring embolization (p < 0.05). Of these, more than two injured arteries requiring embolization (odds ratio, 16.0; 95% confidence interval, 2.9-88) and transfusion of >2 U of blood per hour (odds ratio, 6.9; 95% confidence interval,1.9-25) were independent predictors of recurrent hemorrhage. CONCLUSION: Angiographic control of traumatic pelvic arterial hemorrhage is highly successful. However, recurrent pelvic arterial hemorrhage does occur. We identified a subgroup of patients with pelvic fractures who are at increased risk of recurrent pelvic arterial hemorrhage and should be considered for early repeat angiography for signs of ongoing hemorrhage.
Authors:
David Gourlay; Eric Hoffer; Milton Routt; Eileen Bulger
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  59     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-12-30     Completed Date:  2006-02-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1168-73; discussion 1173-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA.
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MeSH Terms
Descriptor/Qualifier:
Acetabulum / blood supply,  injuries,  radiography
Adult
Female
Fractures, Closed / radiography*
Hemorrhage / radiography*
Humans
Injury Severity Score
Logistic Models
Male
Middle Aged
Pelvic Bones / injuries*
Pelvis / blood supply*,  radiography*
Pubic Bone / blood supply,  injuries,  radiography
Recurrence
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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