Pelvic Arterial Injury
Reviewed and revised 6 June 2016
OVERVIEW
- potentially lethal complication of pelvic trauma
- more common that previously reported: >10%
SITES
- gluteal arteries – SIJ and sacral fractures
- pudendal arteries – pubic ramus fractures and widening of the pubic symphysis
WHEN TO SUSPECT
- elderly
- AP compression or vertical shear mechanism
- haemodynamic compromise
- open pelvic fracture
- vascular blush or large hematoma on CT
- Fractures of the sacrum, SI joint or pubic symphysis widening
MANAGEMENT
- Standard approach to major trauma
- Operative intervention is generally unsuccessful, ligation of the iliac arteries or their branches may be required
- If ‘controllable hypotension’ or only BP lability then IR for transcatheter arterial embolisation is preferred
- Aortic tamponade with an inflated intra-aortic balloon pump can be perfromed as a rescue manourvre
References And Links
LITFL
- Weingart on Pelvic Trauma
- Pelvic and Hip injuries in the Emergency Department
- Trauma Tribulation 026 — Trauma! Genitourinary injuries
- CCC — Pelvic arterial injury
- CCC — Pre-peritoneal packing
- CCC — Pelvic Fracture Management
Journal articles and textbooks
- Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, Holevar M, Sabater EA, Sems SA, Vassy WM, Wynne JL. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture–update and systematic review. J Trauma. 2011 Dec;71(6):1850-68. PMID: 22182895.
- Fildes J, et al. Advanced Trauma Life Support Student Course Manual (8th edition), American College of Surgeons 2008.
- Heetveld MJ, Harris I, Schlaphoff G, Sugrue M. Guidelines for the management of haemodynamically unstable pelvic fracture patients. ANZ J Surg. 2004 Jul;74(7):520-9. Review. PubMed PMID: 15230782.
- Legome E, Shockley LW. Trauma: A Comprehensive Emergency Medicine Approach, Cambridge University Press, 2011.
- Marx JA, Hockberger R, Walls RM. Rosen’s Emergency Medicine: Concepts and Clinical Practice (7th edition), Mosby 2009. [mdconsult.com]
- Suzuki T, Smith WR, Moore EE. Pelvic packing or angiography: competitive or complementary? Injury. 2009 Apr;40(4):343-53. Epub 2009 Mar 17. Review. PubMed PMID: 19278678.
- White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury. 2009 Oct;40(10):1023-30. Epub 2009 Apr 16. Review. PubMed PMID:19371871.
FOAM and web resources
- LITFL — Weingart on Pelvic Trauma
- Resus.ME — Exsanguinating pelvis – occlude the aorta
- The Trauma Professional’s Blog — Bleeding And Pelvic Fractures
- The Trauma Professional’s Blog — Predicting Bleeding In Patients With Stable Pelvic Fractures
- The Trauma Professional’s Blog — Pelvic Fractures: OR vs Angio In The Unstable Patient
- Trauma.org — Management of exsanguinating pelvis injuries
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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