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Percutaneous transcatheter embolization for massive bleeding from pelvic fractures.

The effectiveness of transcatheter embolization was studied prospectively from January 1977 through July 1984 in 31 patients with extensive pelvic fractures, hypotension, and large retroperitoneal hematomas. The indications for angiography in patients with pelvic fractures included: four or more units of blood transfusion within 24 hours, six or more units of blood transfusion within 48 hours, negative or borderline peritoneal tap and lavage in an unstable patient, or large pelvic retroperitoneal hematoma discovered at time of celiotomy. Successful embolization with complete control of hemorrhage was achieved in 27 patients (87.1%). Overall mortality was 35.5%, but was primarily due to associated injuries. Percutaneous transcatheter embolization was the procedure of choice for controlling massive pelvic retroperitoneal hemorrhage. Early embolization was imperative in reducing transfusion requirements and associated complications.