Background: This case series report discusses patients presenting with hemorrhage and hemodymanic\r\ncompromise due to severe pelvic fractures and undergoing intraoperative angioembolization (IAE) with other\r\nresuscitative procedures.\r\nMethods: We used portable digital subtraction fluoroscopy units for IAE in patients with severe pelvic hemorrhage\r\nand hemodynamic instability (5/03-4/09). Data was collected on demographics, injury severity, resource utilization,\r\nand outcomes at our Level 1 trauma center.\r\nResults: There were 6,538 adult admissions with 912 having pelvic fractures and 65 of these undergoing pelvic\r\nangioembolization. Twelve hemodynamically compromised patients (10 males, 2 females) had intraoperative pelvic\r\nangiography (age: 22-79 years; mean 51.3 �± 17.4). Injury severity score (ISS) was 37.5 �± 8.4 (22-50). Mean\r\nemergency department (ED) length of stay (LOS) was 57.4 min �± 47.9 with 10 patients transported directly to the\r\nOR and 2 to the SICU prior to OR. Ten of 12 patients underwent exploratory laparotomy followed by\r\nangioembolization. Mortality was 50%. Among the 6 survivors (ISS 22 - 50), all had a pre-op CT scan, five had an\r\ninitial base deficit <13, and four were transfused = 6 units pre-incision/pre-procedure. Four of the 6 survivors had\r\nunilateral embolization. In contrast, all 6 non-survivors (ISS 29-41) required massive transfusion prior to OR (>6 units\r\nPRBCs) with 4 having a based deficit >13. Three of these patients bypassed CT and five underwent bilateral internal\r\niliac embolization (BIIE).\r\nConclusions: IAE for severe pelvic hemorrhage can be successfully performed concurrently with exploratory\r\nlaparotomy, pelvic packing or other resuscitative procedures. Patients most likely to benefit have a base deficit <13,\r\nand do not require massive transfusion prior to IAE or suffer from a vertically unstable pelvis fracture
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