Western Trauma Association
Management of Pelvic Fracture with Hemodynamic Instability
Annotation for Point I
In the setting of pelvic fracture related hemorrhage, an
aortogram with bilateral runoff is followed by selective
injections into both iliac systems. If extravasation of
contrast is seen, documenting arterial bleeding, selective
embolization with coils or foam should be performed.
Evidence of vessel spasm, or abrupt cutoff of named vessels
are also signs of injury and strong consideration should be
given to embolization in those circumstances. This approach
is reported successful in 87% in one study.33
A prospective study of angiography and embolization reports
an 80% rate of embolization with pelvic and visceral
angiography, with 95% effectiveness.34
If the patient stabilizes after angio-embolization, the
patient should then get completion of the trauma evaluation
including computed tomography (CT) scans and any needed
plain radiographs.
