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Research Article: Association of prophylactic transcatheter arterial embolization with perioperative blood loss and operative time in complex acetabular fractures: a propensity score-matched retrospective study

Date Published: 2026-08-05

Abstract:
To evaluate the association of preoperative prophylactic transcatheter arterial embolization (PTAE) with perioperative blood loss and operative time in hemodynamically stable acetabular fractures, and to explore outcomes associated with different embolization strategies. We retrospectively analyzed 304 patients treated between January 2023 and March 2025, including 106 who underwent PTAE and 198 who underwent open reduction and internal fixation without preoperative embolization. Propensity score matching generated 89 matched pairs. Intraoperative blood loss, total drainage output, hidden blood loss, total blood loss, and operative time were compared. Separate multivariable linear regression models were used for total blood loss and operative time. Within the PTAE cohort, outcomes were also compared between superselective superior gluteal artery (SGA) embolization and internal iliac artery (IIA) trunk embolization. Angiography identified occult vascular injuries in 15 of 106 PTAE patients (14.15%). After matching, PTAE was associated with lower intraoperative blood loss, total drainage output, hidden blood loss, and total blood loss, as well as shorter operative time (all p <?0.001). Multivariable analyses confirmed independent associations with lower total blood loss ( ? =??204.71, p <?0.001) and shorter operative time ( ? =??22.116, p <?0.001). In exploratory subgroup analysis, blood loss outcomes and operative time did not differ significantly between the SGA and IIA groups, whereas the SGA group had lower 24-h postoperative VAS scores (4.19?±?1.90 vs. 6.03?±?2.01, p <?0.001). In this propensity score-matched retrospective cohort, preoperative PTAE was associated with lower perioperative blood loss and shorter operative time. Superselective embolization of anatomically high-risk vessels may be a potential strategy for perioperative vascular management, but subgroup findings should be interpreted cautiously.

Introduction:
Pelvic and acetabular fractures (PAFs) account for approximately 1.5–3% of all fractures ( 1 ) and typically result from high-energy trauma. Due to their complex anatomy and proximity to major vascular and visceral structures, PAFs often occur in the setting of polytrauma and are associated with substantial morbidity and mortality, particularly in the setting of hemorrhagic shock (8–37%) ( 2 , 3 ), with acute major hemorrhage representing a leading cause of early mortality ( 4 ). In hemodynamically unstable…

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