Prognostic factors in endovascular treated pelvic haemorrhage after blunt trauma

Rafael Rehwald, Elisabeth Schönherr, Johannes Petersen, Hans-Christian Jeske, Anna Fialkovska, Anna Katharina Luger, Astrid Ellen Grams, Alexander Loizides, Werner Jaschke, Bernhard Glodny

Angioembolization is the method of choice for treating haemorrhage after blunt pelvic trauma. The aim of this study was to determine technical factors related to endovascular procedures which might be related to patient outcome. This retrospective study included 112 consecutive patients (40 women and 72 men; mean age 57.2 ± 20.0). There were age peaks at 43 and at 77 years. Patients over 65 years had mainly "low-energy" trauma; younger patients were more likely to have polytraumas. Younger patients were more severely injured and had more surgical interventions, larger haematoma volumes, lower Hb levels and required more transfusions than older patients. Women were older than men, had fewer surgeries and waited longer for an angiography (p < 0.05 each). Logistic regression analyses identified the injury severity score (ISS) as relevant for survival before age, haematoma volume and Hb. Propensity score analyses showed that in addition to the need for transfusions, haemoglobin, and haematoma volume, the length of the coils and the number of microcoils used were relevant (p < 0.05 each). The location of haemorrhage in peripheral parietal arteries (superior and inferior gluteal artery) was an influencing factor for re-angiographies, which were associated with considerably longer hospital stays of more than 40 days. Fewer particles had generally been used in these patients. The use of too few coils and not using microparticles in angioembolization for pelvic haemorrhage are major influencing factors for the mortality or re-angiography rate. Special attention should be given to thorough peripheral embolization with microcoils, in particular for haemorrhage from the parietal branches of the internal iliac artery.