Stent graft treatment of an external iliac artery injury associated with pelvic fracture. A case report.

Abstract

The management of life-threatening hemorrhage after blunt pelvic trauma is a multidisciplinary challenge 1,2. Although the cancellous bone and venous plexuses are the most frequent sources of bleeding with pelvic fractures, arterial bleeding is the primary cause of life-threatening hemorrhagic shock in patients with pelvic trauma 2,3. The most common source of arterial bleeding is the internal iliac artery, and injury to this artery is usually managed with angiographic embolization 3-5. Injury to the external iliac artery, especially with active bleeding, is far less frequent 6,7 and should be managed with reconstructive techniques to avoid lower-extremity ischemia. Gaining surgical access to the external iliac artery in a patient with multiple injuries and a retroperitoneal hematoma is difficult and hazardous. Percutaneously inserted endovascular stents are increasingly being used to treat vascular injuries 8-10. In this report, we describe the use of a stent graft in the management of life-threatening hemorrhage due to laceration of the external iliac artery in association with pelvic fracture. Our patient was informed that data concerning this case would be submitted for publication. A sixty-one-year-old man was brought to the traumatology department at our institution after he attempted to commit suicide by jumping from the second-floor balcony of a nursing home. The medical history of the patient was remarkable for depression, a left nephrectomy performed secondary to an accident two years previously, and severe hypertension controlled by a combination of antihypertensive drugs. He was intubated prior to his arrival at the hospital. The blood pressure was 110/90 mm Hg with a pulse of 100 bpm, and the Glasgow Coma Scale score was 3T. The patient …