Utility of pelvic CT angiography in blunt pelvic trauma

Purpose

To assess the clinical utility of pelvic computed tomography angiography (CTA) in predicting the need for intervention following blunt traumatic pelvic vascular injury, independent of other trauma severity assessment metrics.

Materials and methods

This retrospective study was IRB approved and HIPAA compliant; informed consent was waived. Eligible patients presented with blunt abdominopelvic trauma and underwent triple-phase pelvic CTA on admission from 1/1/2006 - 8/31/2019. Of the 21,162 eligible patients, 350 met criteria (males 225, females 125, mean age 42 years, range 11-96 years). Vessels were evaluated for contrast extravasation, occlusion, narrowing/spasm, dissection, and pseudoaneurysm. Fisher's exact test was used to compare differences in outcome based on vascular injury on CTA.

Results

74 of 350 (21%) patients demonstrated vascular injury on CTA. 65 had arterial extravasation, 12 had venous injury, 3 had thrombosis, 3 had pseudoaneurysm, 1 had dissection, and 16 had arterial narrowing/spasm.

42 of 65 (65%) patients with active arterial extravasation on pelvic CTA underwent conventional angiography, and 31 demonstrated active bleeding requiring intervention; 5 patients without extravasation underwent negative conventional angiographies. None of the 276 patients without active arterial extravasation received intervention, and all survived. Contrast extravasation on admission pelvic CTA significantly predicted the need for direct intervention and overall mortality (p<0.0001).

Conclusion

Pelvic CTA can be safely implemented in trauma imaging protocols to diagnose vascular injury and determine the need for subsequent intervention. Absence of contrast extravasation on CTA precludes the need for further intervention, independent of newer trauma severity assessment metrics.