Protocolo de embolizacion arterial como parte del control de la hemorragia por fractura pélvica: serie de casos en un centro de referencia de trauma

Autores/as

  • Cesar Eduardo Jimenez Clínica Medical. Bogotá, Colombia
  • Leonardo Randial Clínica Medical. Bogotá, Colombia
  • Camilo Abril Clínica Medical. Bogotá, Colombia
  • Carlos Arias Clínica Medical. Bogotá, Colombia
  • Fernando Quiroga Fundación Sinergia. Bogotá, Colombia

DOI:

https://doi.org/10.1016/j.rccot.2020.06.004

Palabras clave:

fractura pélvica, sangrado pélvico, embolización, pelvis

Resumen

Introducción: Las fracturas pélvicas se asocian a sangrado arterial y/o venoso, ocasionando mortalidad elevada. El objetivo del estudio es diseñar, implementar y evaluar un protocolo para el tratamiento de fracturas pélvicas
Materiales y métodos: estudio prospectivo observacional, de pacientes con fractura pélvica que ingresaron a la clínica Medical. Variables: edad, sexo, arteria comprometida, lesión unilateral o bilateral, tipo de fractura pélvica (clasificación de Tile), indicación de la arteriografía, acceso uni o bilateral, éxito angiográfico, complicaciones del procedimiento, lesiones asociadas, mortalidad a 30 días, mecanismo de trauma, días de estancia en cuidado intensivo.
Resultados: 56 pacientes con fractura pélvica, 17 pacientes se llevaron a arteriografía pélvica por sospecha de sangrado, 14 pacientes tenían sangrado arterial, promedio de 36 años, las arterias más comúnmente lesionadas fueron la arteria hipogástrica, arteria sacra lateral y la arteria obturatriz. la mayoría de sangrados se asociaron a fracturas tipo C, las lesiones asociadas se encontraron en un 34% de casos, la indicación de la arteriografía fue inestabilidad hemodinámica al momento del ingreso, el control del sangrado se logró en el 86% de casos, la punción fue única en el 100% de casos, se requirió empaquetamiento pélvico 12% de casos.
Discusión: El trauma pélvico asociado a accidentes de motocicleta es común, el manejo multidisciplinario y la oportuna intervención del cirujano vascular es decisiva para el diagnóstico y tratamiento temprano de las lesiones vasculares pélvicas; la realización de un protocolo de manejo con un algoritmo de embolización mostró ser efectivo y seguro para el control del sangrado pélvico.
Nivel de Evidencia: III

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Biografía del autor/a

Cesar Eduardo Jimenez, Clínica Medical. Bogotá, Colombia

Jefe de servicio de cirugía vascular, clínica Medical, Bogotá, Colombia

Leonardo Randial, Clínica Medical. Bogotá, Colombia

Cirujano vascular clínica Medical, Bogotá, Colombia.

Camilo Abril, Clínica Medical. Bogotá, Colombia

Jefe de Ortopedia clínica Medical, Bogotá, Colombia.

Carlos Arias, Clínica Medical. Bogotá, Colombia

Cirujano Vascular clínica Medical, Bogotá, Colombia

Fernando Quiroga, Fundación Sinergia. Bogotá, Colombia

Fundación Sinergia. Bogotá, Colombia

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Publicado

2020-07-19

Cómo citar

1.
Jimenez CE, Randial L, Abril C, Arias C, Quiroga F. Protocolo de embolizacion arterial como parte del control de la hemorragia por fractura pélvica: serie de casos en un centro de referencia de trauma. Rev. colomb. ortop traumatol. [Internet]. 19 de julio de 2020 [citado 23 de abril de 2024];34(2):102-13. Disponible en: https://revistasccot.org/index.php/rccot/article/view/261

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