Trauma-associated bleeding from the bilateral internal iliac arteries resolved using angiographic embolization

Area of Science:

• Trauma Surgery
• Interventional Radiology
• Emergency Medicine

Background:

• Major pelvic injuries present significant management challenges in trauma care.
• High mortality rates are associated with pelvic fractures, necessitating effective hemorrhage control strategies.

Observation:

• A 39-year-old male sustained a pelvic fracture from a 500 kg load, presenting with unstable vital signs.
• Pelvic tomography revealed fractures, iliopsoas hematoma, and active hemorrhage in the left internal iliac artery.
• Despite resuscitation, the patient's hemodynamics deteriorated, prompting emergent intervention.

Findings:

• Bilateral iliac artery embolization was performed to control active hemorrhage.
• Post-embolization angiography confirmed successful occlusion of bleeding vessels.
• The patient ultimately expired due to acute kidney failure, disseminated intravascular coagulation, and multi-organ failure.

Implications:

• Angiographic embolization is a valuable tool for hemorrhage control in pelvic trauma.
• This intervention carries potential complications, including ischemia and necrosis, requiring careful patient selection and monitoring.
• Further research is needed to optimize outcomes and mitigate risks associated with embolization in severe pelvic injuries.