Gluteal muscle necrosis following transcatheter angiographic embolisation for retroperitoneal haemorrhage associated with pelvic fracture

Transcatheter angiographic emobilisation has been used as an effective cont rol of haemorrhage associated with pelvic fracture. Although few complicati ons of this procedure have been reported, gluteal muscle necrosis occurs oc casionally. We assessed the type of pelvic fracture, concomitant injury, em bolic site, embolic materials, and outcome in cases of gluteal muscle necro sis associated with angiographic embolisation for pelvic fracture-related h aemorrhage, and investigated the factors associated with the development of gluteal muscle necrosis, one of the fatal complications of transcatheter a ngiographic embolisation. Five out of the 151 patients (incidence, 3.3%) wh o underwent transcatheter angiographic embolisation for haemorrhagic shock due to pelvic fracture developed gluteal muscle necrosis after embolisation . The five cases had injury severity scores ranging from 26 to 59 (mean 46. 4). Three patients died (mortality, 60%) of subsequent sepsis and dissemina ted intravascular coagulation. These cases showed that transcatheter angiog raphic embolisation with gelatin sponge and/or steel coil, while effectivel y controlling bleeding, may also result in gluteal muscle necrosis. Aggress ive management including intraarterial antibiotic treatment may have a role , but our numbers are too small to confirm this. (C) 2001 Elsevier Science Ltd. All rights reserved.