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J Trauma Inj > Volume 29(4); 2016 > Article
Journal of Trauma and Injury 2016;29(4):161-166.
DOI: https://doi.org/10.20408/jti.2016.29.4.161    Published online December 31, 2016.
Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture
Jihun Gwak, Yong Cheol Yoon, Min A Lee, Byungchul Yu, Myung Jin Jang, Kang Kook Choi
Department of Trauma Surgery, Gachon University, Gil Medical Center, Incheon, Korea. choikangkook@gilhospital.com
Received: 7 December 2016   • Revised: 10 December 2016   • Accepted: 31 January 2017
Abstract
PURPOSE
Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography.
METHODS
This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015.
RESULTS
Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%).
CONCLUSION
The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications.
Key Words: Pelvic bones; Fractures; Bone; Hemorrhage; Embolization; Therapeutic


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