Clinical Outcomes of Different Angioembolization Techniques and Materials for Hemodynamically Unstable Pelvic Fractures: An Overlap Weighted Study.

Abstract

Background: Internal iliac artery embolization (IIAE) is a critical hemostatic intervention for controlling hemorrhage in patients with hemodynamically unstable pelvic fractures (HUPF). However, the optimal technique-nonselective versus selective embolization-and the choice of embolic materials remain debated. This study compares the efficacy, safety, and clinical outcomes of nonselective embolization (NSE) and selective embolization (SE) techniques in patients with HUPF. A secondary analysis examined the impact of different embolic materials on patient outcomes.

Methods: This multicenter retrospective study included patients aged 16 and older with HUPF who underwent IIAE. Patients were categorized into NSE or SE groups. Key outcomes included 24-h red blood cell (RBC) transfusion volume, duration of angioembolization (AE), complications, mortality, and infection rates. Propensity score overlap weighting (PSOW) was used for comparisons, with validation via propensity score matching (PSM). Subgroup analyses also employed PSOW to assess outcomes based on embolic materials.

Results: A total of 296 patients with HUPF met the inclusion criteria, with 214 undergoing NSE and 82 receiving SE. After PSOW, near-perfect comparability between the two groups was achieved (SMDs = 0). The NSE group had significantly lower 24-h RBC transfusion volumes (2.00 vs. 4.00 units, MD, -2 units; 95% CI, -2.0 to 0; and p = 0.018) and shorter AE duration (65 vs. 80 min, MD, -15 min; 95% CI, -20 to -5.16; and p < 0.001). NSE group also required less 24-h plasma transfusion. Although the NSE group showed higher rates of deep vein thrombosis and urinary tract infection in PSOW analysis, subsequent PSM analysis revealed no significant differences between groups. Similarly, both groups showed comparable rates of other complications, hospital costs, and mortality rates. Subgroup analysis showed that the gelatin sponge (GS) group had higher 24-h RBC transfusion volumes and longer AE durations, though these were not statistically significant. Notably, the GS group had significantly higher rates of pulmonary infections and incision/pin tract infections.

Conclusion: Nonselective embolization appeared to be associated with reduced RBC transfusion needs and provide faster hemorrhage control, though this did not translate to a survival benefit. The evidence regarding NSE's effect on specific complication risks was inconclusive. Subgroup analysis showed coils were associated with fewer complications than GS. Further prospective studies are needed to clarify the optimal technique and materials.