Application of transcatheter arterial embolization in patients with severe pelvic fractures. Analysis by helical contrast-enhanced CT and Young-Burgess sub-classification

Indication of transcatheter arterial embolization (TAE) is based on vital signs and extravasation on contrasted CT. Hematoma without extravasation of contrast material could be bleeding from veins or bone marrow. We evaluated the usefulness of contrasted CT with Young-Burgess sub-classification in determining whether TAE is indicated. We performed a retrospective review of 67 patients with severe pelvic fractures. All had undergone both pelvic angiography and preangiographic helical contrasted CT. The fractures were classified according to Young-Burgess sub-classification and extravasation on angiography was compared with helical contrasted CT findings. Extravasation on helical contrasted CT and bleeding arteries on angiography were divided into anterior and posterior segments. Extravasation was seen in 15 cases on helical contrasted CT and 43 cases in angiography. False positive (extravasation on CT but not angiography) was noted in 2 cases. False negative (Extravasation on angiography but not helical contrasted CT) was noted 29 cases. Sensitivity was 30% and negative predictive value was 42%. There were more false negatives in lateral compression type II and III, anteroposterior compression type III, vertical shear and complex pattern (with instability of the pelvic ring) fractures. Even though sensitivity in detecting extravasation is low, helical contrasted CT using Young-Burgess sub-classification is useful in identifying hematoma with arterial injury and in determining whether TAE is indicated. (author)