Angiographic embolization of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis

Angiographic embolization of bleeding pelvic vessels is increasingly used i n patients with pelvic injuries. Temporary angiographic embolization of bil ateral internal iliac arteries (TAEBIIA) is occasionally necessary. From No vember 1991 to March 1998, 30 consecutive patients (mean age of 43 years, m ean Injury Severity Score of 25) with complex pelvic fractures underwent TA EBIIA to control severe hemorrhage not responding to subselective embolizat ion. Angiography revealed multiple sources of pelvic bleeding in 28 (93%) p atients. In the two remaining patients, no bleeding was identified but TAEB IIA was done empirically. Thirteen patients had laparotomies before TAEBIIA with unsuccessful bleeding control, and the remaining 17 had TAEBIIA as th e primary treatment. After TAEBIIA 90 per cent of patients had successful c linical (27 of 30) and radiographic (25 of 28) control of bleeding. Of the three patients who continued to bleed after TAEBIIA two were successfully r e-embolized and one died of acute cardiac failure before any further interv ention was attempted. TAEBIIA had a success rate of 97 per cent (29 of 30) in controlling pelvic hemorrhage without significant complications related to it. TAEBIIA is a safe and effective alternative to subselective emboliza tion in controlling retroperitoneal bleeding in selected patients with blun t pelvic trauma.