Does Pelvic Angioembolization Increase Pelvic Ischemic Complication? A Multicenter American Association for the Surgery of Trauma Study.

Background: Controversy exists if pelvic angioembolization (PAE) causes ischemic complications of the pelvis and if selective vs non-selective embolization influences the risk of these complications.

Methods: We conducted a multicenter prospective observational study of adult blunt trauma patients with pelvic fractures who underwent angiography over 55 months. Patients who underwent angiography were divided into four groups: no embolization (No-Embo), selective embolization (Sel), unilateral nonselective embolization (Non-Sel) and bilateral Non-Sel embolization (B-Non-Sel). The primary outcome was ischemic complications; defined as gluteal skin/muscle necrosis, pelvic abscess, pelvic wound infection, pelvic wound breakdown, and osteomyelitis of the pelvis or femoral head.

Results: Of the 460 patients undergoing angiography, pelvic ischemic complications occurred in 45 patients (9.8%). Of these 45 patients, 4 patients were in the No-Embo group (5.1%), 24 patients (10.0%) in the Sel group, 11 patients (15.1%) in the Non-Sel group, and 6 patients (8.8%) in the B-Non-Sel. There was no significant difference when comparing the groups on univariate analysis (p=0.23), multivariable analysis (Sel OR=2.16, p=0.3; Non-Sel OR=4.17, p=0.07; B-Non-Sel OR=1.00, p=0.99) nor when comparing each complication individually.

Conclusion: The current study is the largest to date of blunt pelvic fracture patients undergoing angiography. Upon comparing those not embolized with those selectively and non-selectively embolized, we found no association between PAE and pelvic ischemic complications. The decision of when and where to embolize should be individualized to the injury encountered and the stability of the patient.