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Doctoral Thesis
DOI
10.11606/T.5.2008.tde-28012009-153629
Document
Author
Full name
Guilherme de Palma Abrão
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2008
Supervisor
Committee
Caldas, José Guilherme Mendes Pereira (President)
Orlando, José Luiz
Ramos Júnior, Francisco Ferreira
Saito, Osmar de Cassio
Santos, Alair Augusto Sarmet Moreira Damas dos
Title in Portuguese
Embolização arterial no traumatismo de bacia
Keywords in Portuguese
Angiografia
Choque hemorrágico
Embolização terapêutica
Estudos prospectivos
Pelve/lesões
Prognóstico
Abstract in Portuguese
O trauma pélvico apresenta alta morbi-mortalidade, especialmente nos casos de dupla ruptura do anel pélvico (AP), devido à hemorragia. O objetivo deste trabalho é observar o tempo transcorrido até a realização do tratamento endovascular (TE), a sua eficácia e a estratégia de exames complementares empregado. 53 pacientes com fratura de bacia póstraumática foram submetidos a embolização arterial num estudo retro e prospectivo, realizado no período de janeiro de 2000 e dezembro de 2005. A idade dos pacientes variou entre 93 e 17 anos, com média de 37,5 anos. Houve predomínio do sexo masculino, com cerca de 62,2%. A causa do trauma mais freqüente foi o acidente de moto em 36% dos casos. Predominaram as fraturas com dupla ruptura do AP em 71,6 % dos casos. 49 pacientes apresentavam instabilidade hemodinâmica, e desses, todos receberam derivados sanguíneos previamente à realização do TE. Neste estudo 38,7% (n = 19) dos pacientes instáveis foram submetidos ao exame de tomografia computadorizada (TC) antes do TE, o tempo médio desse grupo para atingir a sala de radiologia vascular foi de 230,45 minutos. Nos pacientes enviados diretamente à arteriografia com intenção terapêutica, o tempo médio até início da realização do tratamento foi de 146,77 minutos. A diferença entre as taxas de mortalidade precoce nos grupos de pacientes submetidos ou não a TC previamente ao TE foi de 5,63%. O choque hemorrágico foi à causa de óbito em 63,33% dos pacientes que apresentaram mortalidade precoce. Na conduta inicial desses pacientes preconiza-se realizar o menor número de intervenções até o controle da hemorragia. O tempo transcorrido até a chegada na sala de radiologia vascular é fator importante no prognóstico dos pacientes com fraturas hemorrágicas da bacia. O TE precoce é uma importante ferramenta nos pacientes hemodinamicamente instáveis inicialmente
Title in English
Arterial embolisation on pelvic trauma
Keywords in English
Angiography
Hemorrhagic shock
Pelvic/injury
Prognostic
Prospective study
Therapeutic embolization
Abstract in English
Pelvic trauma presents high morbi-mortality specially in cases of double rupture of pelvic ring due to hemorrhages. The objective of this work is to observe the time period since the rupture till the execution of endovascular treatment (ET) as well as the effectiveness and strategy for the used complementary exam. 53 patients with pos-traumatic pelvic fracture were submitted to arterial embolization during retro and prospective study. Such study was executed during the period of January 2000 to December 2005. The age of the patients varied between 17 and 93 years old, average 37.5 year old and predominantly men at about 62.2% of the cases. The most frequent cause of the traumas, 36%, was motorcycle accident. Predominantly fractures with double rupture of the pelvic ring, that is 71.6% of the cases. 49 patients presented hemodynamic instability, all of them received blood derivatives previously to the ET execution. In this study 38.7% (n=19) of the unstable patients were submitted to computerized tomography exam (CT) before the ET. The average period of time for this group to reach the room of vascular radiology was 230.45 min. For patients sent straight to arteriography with therapeutic intention, the average period time was 146.77 min. The difference, between the early mortality rate of the group undertaken or not to the CT previously to the ET, was 5.63%. The hemorrhagic shock was the cause of death in 63.33% patients, who presented early mortality. For the initial on going study of these patients, we recommend to accomplish the least number of interventions until hemorrhage is controlled. The elapsed time till the arrival at the vascular radiology room is an important factor to make prognosis about patients with hemorrhagic pelvic fractures. The early ET is an important tool for patients with hemodynamic instability
 
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Publishing Date
2009-02-04
 
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