High incidence of ischemic necrosis of the gluteal muscle after transcatheter angiographic embolization for severe pelvic fracture

Background: After transcatheter angiographic embolization (TAE), massive gluteal muscle necrosis was found in patients during open reduction and internal fixation for pelvic fracture. Methods: In our six patients, magnetic resonance imaging (MRI) scans obtained I and 4 weeks after TAE demonstrated ischemic damage of the gluteal muscle. Results: Total reopening of the embolized artery was confirmed in only one case on the second angiogram obtained 1 month after TAE. In five patients, massive muscle necrosis, previously confirmed on MRI, was macroscopically found during open reduction and internal fixation or debridement surgery. In two patients, severe complications developed, such as soft tissue infection caused by necrosis, skin necrosis accompanied by subcutaneous infection, and sepsis. Conclusions: MRI revealed that TAE more frequently causes profound ischemic damage or necrosis than has been thought. This will be a warning to those who use TAE. Before definitive stabilization, external fixation may be recommended as a first-choice procedure for resuscitation and, then, unilateral selective TAE.