During the study period, 162 patients with severe trauma were studied. The characteristics of study patients are shown in Table 1. The median age was 54 (36–71) years and 62% were male. The most frequent trauma mechanism was a motor vehicle collision (49%) and the second most frequent mechanism was a fall (41%). The median ISS was 27 (18–38). The median time to blood transfusion was 79 (29–135) minutes, the time to angiography was 87 (59–123) minutes and the median procedure time was 70 (50–95) minutes. There was no significant difference between time to blood transfusion and time to angiography (p = 0.583). Approximate 28% (46/162) patients underwent no blood transfusion within 24hours from arrival. Regarding mortality, a total of 17 deaths in the cohort (10.0%) as a result of severe head injury (n = 10, 59%) and hemorrhagic shock (n = 7, 41%).
Table 1
Characteristics of study patients
Characteristic | Study patients (n = 162) |
Age, y | 54 (36–71) |
Sex, male, n (%) | 100 (62) |
Trauma mechanism, n (%) Motor vehicle collision Fall Penetrating Other blunt mechanism Unknown | 79 (49) 67 (41) 6 (3.7) 9 (5.5) 1 (0.6) |
Admission physiology Systolic BP, mmHg GCS INR Systolic BP < 90 mmHg, n (%) GCS < 9, n (%) INR > 1.2, n (%) | 113 (88–141) 14 (9–15) 1.1 (1.0–1.3) 45 (28) 35 (21) 58 (36) |
Injury data Head AIS Chest AIS Abdomen AIS Pelvis AIS ISS ISS > 15, n (%) | 4 (3–5) 3 (3–4) 3 (2–4) 3 (2–4) 27 (18–38) 141 (87) |
Time to blood transfusion. Time to angiography Procedure time | 79 (29–135) 87 (59–123) 70 (50–95) |
Blood transfusion within 24h | 2 (0–9) |
Mortality 30-day mortality, n (%) | 17 (10) |
AIS, abbreviated injury scale; BP, blood pressure; GCS, Glasgow Coma Scale; INR, international normalized ratio; ISS, injury severity score |
Distributions of embolized regions are shown in Fig. 1 and the Supplemental Table. The frequency of embolized regions had the following order: pelvis (n = 96, 59%), abdomen (n = 57, 35%), chest (n = 17, 10%), cerebrovascular (n = 8, 4.9%), other (n = 7, 4.3%), and peripheral (n = 5, 3.1%). Overlapping of embolized regions among pelvis, abdomen, and other body regions, including cerebrovascular, chest, peripheral and other, is shown in Fig. 1. Approximately 13% (n = 21) of patients underwent embolization in two or more regions.
Procedural data according to embolized body regions is shown in Table 2. Embolization in the chest (105 [60–120]; p = 0.004) and other (90 [77–113]; p = 0.036) regions was associated with a longer procedure time compared with whole patients. Gelatin sponge particles were most often used in any body region.
Table 2
Procedural Data for Patients According to Embolized Body Regions
| Pelvis (n = 96) | Abdomen (n = 57) | Chest (n = 17) | Cerebrovascular (n = 8) | Peripheral (n = 5) |
Physiology Systolic BP < 90 mmHg, n (%) INR > 1.2, n (%) | 32 (33) 42 (44) | 13 (23) 13 (23) | 6 (35) 11 (65) | 3 (38) 4 (50) | 1 (20) 1 (20) |
Trauma score ISS | 29 (22–41) | 29 (19–36) | 33 (18–50) | 43 (26–52) | 42 (34–43) |
Procedure time, min | 65 (47–94) | 75 (55–100) | 105 (60–120) | 85 (74–110) | 60 (60–112) |
Embolic material Gelatin, n (%) Coils, n (%) NBCA, n (%) | 94 (98) 0 (0) 7 (7.3) | 47 (83) 5 (8.8) 4 (7.0) | 17 (100) 1 (5.9) 2 (12) | 5 (63) 1 (13) 3 (38) | 4 (80) 0 (0) 1 (20) |
Number of Embolized arteries | 3 (2–4) | 2 (1–2) | 3 (1–4) | 3 (1–6) | 2 (2–3) |
Other hemorrhagic procedures Neurosurgery Thoracotomy Laparotomy Orthopedic OMFS Vascular extremity | 6 (6.3) 9 (9.4) 23 (24) 50 (52) 3 (3.1) 2 (2.1) | 2 (3.5) 2 (3.5) 20 (35) 10 (18) 1 (1.8) 1 (1.8) | 2 (12) 6 (35) 7 (41) 7 (42) 0 (0) 0 (0) | 2 (25) 0 (0) 2 (25) 1 (13) 1 (13) 0 (0) | 2 (40) 0 (0) 1 (20) 3 (60) 0 (0) 0 (0) |
BP, blood pressure; INR, international normalized ratio; ISS, injury severity score; NBCA, n-butyl cyanoacrylate; OMFS, oral and maxillofacial surgery |
The number of embolized arteries did not differ between body regions. Approximately 64% (103/162) of patients underwent concomitant surgery in most orthopedic procedures. Embolized arteries of each region are shown in Table 3. Selective embolization in the pelvis was performed in 64 patients (67%) and in the abdomen for 49 patients (86%). Regarding embolization for pelvic fractures, non-selective embolization (60 [39–83]) had a tendency to be associated with a lower systolic blood pressure (94 [71–125] mmHg) and shorter procedure time (60 [39–83] minutes) compared with selective embolization (112 [80–137] mmHg and 69 [50–10] minutes); however, statistically significant differences in systolic blood pressure (p = 0.092) and procedure time (p = 0.056) were not observed.
Table 3
Details of embolized arteries according to each region
Regions | Details of embolized arteries | Number of the cases with specific embolized arteries |
Pelvis (n = 96) | Internal iliac artery (IIA) Main trunk of IIA Branches of IIA Superior gluteal artery Inferior gluteal artery Internal pudendal artery External pudendal artery Obturator artery Deep iliac circumflex artery Iliolumbar artery Lateral sacral artery Vesical artery Branches of external iliac artery Inferior epigastric artery Medial circumflex femoral artery Lateral circumflex femoral artery Deep femoral artery Median sacral artery Lumber artery | 76 (79%) 43 (45%) 13 (14%) 12 (13%) 13 (14%) 1 (1.0%) 6 (6.3%) 4 (4.2%) 13 (14%) 6 (6.3%) 1 (1.0%) 15 (16%) 8 (8.3%) 3 (3.1%) 7 (7.3%) 3 (3.1%) 4 (4.2%) 22 (23%) |
Abdomen (n = 57) | Splenic artery Hepatic artery Renal artery Adrenal artery Inferior phrenic artery | 28 (49%) 23 (40%) 11 (19%) 2 (3.5%) 2 (3.5%) |
Chest (n = 17) | Intercostal artery Internal mammary artery Lateral thoracic artery Subscapular artery Thoracoacromial artery Unknown branch of subclavian artery | 9 (53%) 8 (47%) 2 (12%) 1 (5.9%) 1 (5.9%) 1 (5.9%) |
Cerebrovascular (n = 8) | Facial artery Maxillary artery Middle meningeal artery Vertebral artery Transverse cervical artery Superficial cervical artery | 3 (38%) 2 (25%) 2 (25%) 1 (13%) 1 (13%) 1 (13%) |
Peripheral (n = 5) | Deep femoral artery | 5 (100%) |
Other (n = 7) | Lumbar artery Deep iliac circumflex artery Inferior epigastric artery Iliolumbar artery Lateral femoral circumflex artery Internal pudendal artery | 4 (57%) 2 (29%) 1 (14%) 1 (14%) 1 (14%) 1 (14%) |
Categorical variables are presented as a number (%). |
The Pearson correlation coefficient between the number of embolized arteries and procedure time was R = 0.357 (p < 0.001; Fig. 2), and between the number of embolized regions and procedure time was R = 0.428 (p < 0.001; Fig. 3). Multiple regression model demonstrated number of embolized arteries (p = 0.021) and number of embolized regions (p < 0.001) were independently associated with procedure time, respectively (Table 4).
Table 4
Multiple regression model of predictor of procedure time
Variables | Partial regression coefficient | p-value | 95% CI |
Age | -0.013 | 0.915 | -0.247-0.222 |
Systolic BP < 90 mmHg | -7.303 | 0.246 | -19.701-5.095 |
GCS < 9 | -0.443 | 0.949 | -14.221-13.335 |
INR > 1.2 | 1.284 | 0.822 | -9.954-12.521 |
ISS > 15 | -4.675 | 0.556 | -20.321-10.972 |
Number of embolized arteries | 4.770 | 0.021 | 0.724–8.817 |
Number of embolized regions | 25.373 | < 0.001 | 13.051–37.694 |
OR, odds ratio; CI, confidence interval; BP, blood pressure; GCS, Glasgow Coma Scale; INR, international normalized ratio; ISS, injury severity score |