Acute pelvic trauma and vascular injuries: the key role of interventional radiology

Pelvic vascular injuries are typically caused by high-energy trauma and they are frequently associated with pelvic ring disruption and have a high mortality rate due to shock as a result of pelvic bleeding. The pelvic bleeding source can be arterial, venous, or osseous, and differentiating an arterial (high-pressure) bleed from a venous-osseous (low-pressure) bleed is of paramount importance in stratification for treatment. This narrative review aims to describe the acute pelvic trauma management and the role of interventional radiology in this field. Literature data were considered according to published metanalysis and narrative reviews in English language on PubMed. Low-pressure venous and osseous bleeds are initially treated with a pelvic binder or external fixation, while high-pressure arterial bleeds require angioembolization or surgical pelvic packing. Arterial embolization is a life-saving procedure in abdominopelvic hemorrhagic patients, mini-invasiveness and repeatability may be considered as relevant advantages. Surgery is not always the optimal solution for stabilization of a patient with polytrauma. The management of trauma patients has evolved in recent decades owing to increasing availability of advanced imaging modalities such as CT and multidetector CT is important in the trauma setting to assess and characterize pelvic vascular injuries with multiphasic acquisition in the arterial and venous phases, which allows differentiation of the common vascular injury patterns. Interventional radiology plays a pivotal role in proper patient management with early embolization protocol.