The role of interventional radiology in stopping intrapelvic bleeding in polytrauma with pelvic injuries (Literature review)

DOI: https://doi.org/10.25512/DIR.2022.16.4.06

For quoting:
Shapkin Y.G., Seliverstov P.A., Stekolnikov N.Y. "The role of interventional radiology in stopping intrapelvic bleeding in polytrauma with pelvic injuries (Literature review) ". Journal Diagnostic & interventional radiology. 2022; 16(4); 61-68.

authors:

Shapkin Y.G.

Seliverstov P.A.

Stekolnikov N.Y.

keywords:

polytrauma

pelvic fractures

intrapelvic bleeding

angiography

transcatheter arterial embolization

Abstract:

Background: mortality in polytrauma with pelvic injuries and intrapelvic bleeding remains high and can be reduced through a multidisciplinary approach to hemostasis.

Aim: was to determine possibilities and tactics of using endovascular interventions to stop intrapelvic bleeding in polytrauma with pelvic injuries.

Material and methods: a search was made for scientific articles in the PubMed database and the Scientific Electronic Library (eLIBRARY.ru), published from 2017 to 2021. Transcatheter embolization of pelvic arteries is an effective method for stopping intrapelvic bleeding and is indicated for detecting extravasation of contrast in computed tomography and angiography. In patients with unstable hemodynamics, embolization can be used if it is possible to perform it no later than 30-60 minutes after the detection of intrapelvic bleeding. Resuscitation endovascular balloon occlusion of the aorta can serve as an important component of the damage control strategy and a bridge to the application of methods for the final control of abdominal and intrapelvic bleeding in patients with unstable hemodynamics and systolic blood pressure less than 70 mm hg.

Conclusion: methods of endovascular surgery do not oppose and do not exclude the use of extraperitoneal pelvic packing and/or external fixation of the pelvis to stop intrapelvic bleeding in case of polytrauma. The choice of methods of hemostasis and the algorithm for their application are determined by the degree of hemodynamic disturbances, the presence of combined injuries, the data of radiation diagnostics, and the technical and logistical resources of the trauma center.