Interventional angiography for treatment of hemorrhage in pelvic trauma

Death related to pelvic trauma is often due to uncontrolled hemorrhage. Traditional surgical repairs have had limited success. Anatomic and clinical studies indicate that arterial bleeding is significant in hemodynamically unstable patients who do not respond to initial resuscitation. Successful management requires coordination between multiple services and the continuation of resuscitative procedures in the angiography suite. Transcatheter techniques provide direct identification of sources of bleeding and permit control of retroperitoneal vessels without release of the tamponade provided by intact tissue planes. Selective catheterization and flow-directed particulate emboli can control bleeding from small arteries at sites of injury. The development of stent-graft technology enlarges the scope of interventional therapy to include the rapid and definitive repair of conduit vessel injury.