Clinical re-evaluation of the relationship between gluteal injuries and embolized arteries in patients with massive hemorrhage following pelvic fracture

Abstract

Purpose: Transcatheter angiographic embolization (TAE) has been widely accepted as a treatment for hemorrhagic shock associated with pelvic fracture. Gluteal muscle necrosis is a rare but potentially fatal complication of TAE. This study aimed to clarify factors associated with safer embolization procedures by evaluating relationships between embolic site and risk of gluteal skin injury.

Methods: We classified embolized arteries into six groups: group A, nonselective embolization from the main internal iliac artery; group B, selective embolization including the superior gluteal artery but excluding the inferior gluteal artery; group C, selective embolization including the inferior gluteal artery but excluding the superior gluteal artery; group D, selective embolization including both the superior and inferior gluteal arteries; group E, selective embolization excluding both the superior and inferior gluteal arteries; and group F, no embolization. We assessed the frequency of gluteal injuries, relationships between gluteal injuries and embolized arteries, and the contributions of selective embolization, conservation of the superior or inferior gluteal artery, and conservation of both the superior and inferior gluteal arteries to reducing the risk of gluteal injury.

Results: Gluteal skin injuries were seen at 15 of 160 sites (9.4%). A significant difference was noted between the nonselective embolization group (group A: 10/82, 12.2%) and selective embolization excluding both the superior and inferior gluteal arteries (group E: 1/39, 2.6%) (p = 0.042).

Conclusions: If possible, we recommend selective embolization avoiding the superior and inferior gluteal arteries.

Keywords: Hip; Pelvic trauma; Soft tissue injuries; Vascular trauma.