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PICTORIAL ESSAY   

Journal of Radiological Review 2020 September-October;7(5):367-75

DOI: 10.23736/S2723-9284.20.00048-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English, Italian

Acute active bleedings after pelvic trauma: imaging and endovascular treatment

Francesco PANE , Antonio BORZELLI, Milena COPPOLA, Francesco GIURAZZA, Francesco AMODIO, Fabio CORVINO, Mattia SILVESTRE, Giuseppe DE MAGISTRIS, Gianluca CANGIANO, Enrico CAVAGLIÀ, Raffaella NIOLA

Unit of Vascular and Interventional Radiology, AORN Antonio Cardarelli, Naples, Italy


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Pelvic trauma represents a frequent clinical condition requiring a careful and appropriate management that has to be correctly led by a multi-disciplinary team owing to its elevated rates of mortality. High-energy trauma is responsible mainly in young patients, while in the elderly low-energy trauma is mostly involved; hemorrhage can happen in patients with pelvic trauma, most often venous, but when it is arterial, a prompt treatment is required. Imaging plays a key role and thanks to development of modern multidetector computed tomography it is possible to identify both possible fractures and eventual active bleedings (high/low flow). Depending on patient hemodynamic and mechanical stability/instability of the fracture, different therapeutic approaches can be employed, such as transcatheter endovascular embolization, in presence of active blushes, which is capable of localizing the active bleeding and to stop it with a “tailored” embolization. In this article, we describe the different angiographic patterns of acute active bleedings after pelvic trauma (considering the entity and classification of fractures and hemodynamic conditions of patients), highlighting the key role of imaging in early diagnosis and the role of angio-embolization as effective mini-invasive treatment to immediately stop active bleedings allowing improvement in survival outcomes.


KEY WORDS: Embolization, therapeutic; Angiography; Multidetector computed tomography

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