Effects of Prophylactic Coil Embolization of Pelvic Arteries on Surgical Outcomes in Hemodynamically Stable Patients with Complex Acetabular Fractures.

Abstract

Objectives: To investigate the efficacy of prophylactic embolization of the internal iliac artery (IIA) or superior gluteal artery (SGA) before open reduction and internal fixation (ORIF) in reducing intraoperative blood loss (IBL) in hemodynamically stable patients with complex acetabular fractures.

Materials and methods: A total of 136 patients with complex acetabular fractures were retrospectively included and divided into the prophylactic transcatheter arterial embolization (PTAE) group and non-PTAE group, depending on whether ipsilateral IIA or SGA was embolized using coils within 3 days before ORIF. Demographic characteristics, injury severity score (ISS), fracture classification, and intraoperative and postoperative data were compared between the two groups. Propensity score matching (PSM) was also performed to balance the baseline characteristics of the patients. The determinants of IBL were investigated using multivariate linear regression analysis.

Results: The PTAE and non- PTAE groups consisted of 64 and 72 patients, respectively. PSM yielded 43 matched pairs. Post-matching, IBL in the PTAE group was less than that in the non-PTAE group (median [interquartile range], 800 [400-1200] mL vs 1300 [1000-1600] mL, p < 0.001). Furthermore, the PTAE group showed a shorter ORIF duration and lower intraoperative and 24-h postoperative blood transfusion requirements (all p < 0.05). Multivariate analysis revealed that PTAE and the duration of surgery were associated with IBL (PTAE: β = -0.407, p < 0.001; duration of surgery: β = 0.237, p = 0.021).

Conclusions: Prophylactic IIA or SGA embolization may be beneficial in reducing IBL during ORIF in hemodynamically stable patients with complex acetabular fractures.