Critical review of pelvic fractures associated with external iliac artery lesion: A series of six cases

Pascarella, R; Torto, Michele Del; Politano, Rocco; Commessatti, Matteo; Fantasia, Rossana; Maresca, A

doi:10.1016/j.injury.2013.10.011

Cited by 25 publications

(19 citation statements)

References 30 publications

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“…Recurrent bleeding through vertical and horizontal anastamoses must be excluded with contralateral (internal iliac artery) and ipsilateral (branches of the aorta and external iliac artery) diagnostic arteriography; • damage to the large arterial and venous trunks is rare and carries a high mortality rate. These are managed specifically (obstruction balloon along the injury/sandwich packing pending repair or coated stent bypass) [50,51]; • a target identified in the obturator territory requires external iliac artery angiography to look for a corona mortis artery if internal iliac arteriography is normal.…”

Section: Embolization Methodsmentioning

confidence: 99%

Pelvic trauma and vascular emergencies

Scemama

Dabadie

Varoquaux

et al. 2015

Diagnostic and Interventional Imaging

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Pelvic ring injuries carry a high mortality rate, the main cause of which, in the first 24hours, is exsanguination. Injured patients are managed by a multidisciplinary damage-control strategy. Unstable patients should have instrumentalized hemostasis without delay. Arterial embolization is an effective way of achieving this and justifies this approach being permanently available in level 1 trauma-centers. After CT assessment of injuries, stable patients can undergo arterial embolization if active arterial bleeding or vascular damage is present. The embolization methods (selective or unselective) and agents used depend on the patient's hemodynamic stage and assessment of the injury whenever possible.

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Section: Embolization Methodsmentioning

confidence: 99%

Pelvic trauma and vascular emergencies

Scemama

Dabadie

Varoquaux

et al. 2015

Diagnostic and Interventional Imaging

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“…The highest risk of injury was to the aberrant obturator artery (arterial corona mortis) and to the obturator artery proper in fractures of the superior pubic ramus, to the internal pudendal artery in fractures of the inferior pubic ramus and the ischial ramus (ischiopubic ramus as a whole), to the superior gluteal artery in hip bone fractures extending into the greater sciatic notch, to the internal iliac artery and iliolumbar artery, and to the lateral sacral arteries in fractures of the lateral part of the sacrum. These arteries are the most commonly reported injured vessels in majority of studies (Requarth and Miller, ; Romano et al, ; Pascarella et al, ; Pohlemann et al, ). In our study, we found that arterial injuries occurred in 10 patients: four cases of internal iliac artery, four cases of external iliac artery, one case of obturator artery proper, and one case of aberrant obturator artery.…”

Section: Resultsmentioning

confidence: 98%

“…One probable explanation can be the strength and elasticity of the arterial wall, which is able to flex in response to pressure from dislocated bony fragments. Another possible explanation can be that bleeding from large arteries in the pelvic region is often rapidly fatal (Requarth and Miller, ; Romano et al, ; Tosounidis and Giannoudis, ; Pascarella et al, ; Comai et al, ; Rudloff and Triantafillou, ; Hussami et al, ). However, we believe that the fundamental explanation of this discrepancy is behind the morphological features of the fracture (Pascarella et al, ; Hussami et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…In Area 2: fractures of the superior pubic ramus may result in injury to the femoral, external iliac, obturator proper, or aberrant obturator (arterial corona mortis) arteries (Requarth and Miller, ; Pascarella et al, ; Hussami et al, ). Injuries to the femoral or external iliac arteries can be caused by vertical fracture lines of both the superior and inferior pubic rami directly beneath the arteries as well as in dislocations caused by shear forces, which are typical in Type C fractures.…”

Section: Discussionmentioning

confidence: 99%

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Where and what arteries are most likely injured with pelvic fractures?

et al. 2019

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Blood vessels passing through pelvic region come into intimate contact with pelvic bone and can be injured by the sharp edges of the dislocated fracture fragments. The aim of the study was to evaluate the influence of localization, shape, and dislocation of individual pelvic ring bones' fractures on arterial injuries. The study group consisted of 474 patients enrolled in a 1‐year prospective multicenter study. The pattern of pelvic fracture lines was characterized and recorded on a planar diagram of the subjected side of the pelvis. The diagram was subdivided into 11 designated areas. Frequency of injury at each 11 areas was recorded. The course of individual arteries in the 11 areas was also recorded in relation to each type of pelvic fractures. Out of the 474 investigated patients, the highest proportion of fractures occurred in the areas of the superior (62%) and inferior (59%) ramus of the pubis as well as in the lateral part of the sacrum (19%). These locations can be associated with injuries of the external iliac, obturator, internal iliac, and aberrant obturator arteries. The highest risk of arterial injuries was associated with vertically displaced fractures in the middle part of the superior and inferior pubic rami, along the ischial ramus, in the apex of the greater sciatic notch and in the vicinity of the ventral part of the sacroiliac joint, where the artery runs at a distance of less than 1 cm from the bone. Clin. Anat. 32:682–688, 2019. © 2019 Wiley Periodicals, Inc.

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“…Les faux anévrismes distaux peuvent cependant être traités par une occlusion de la porte d'entrée seulement. Une reprise du saignement par des anastomoses verticales et horizontales doit être éliminée par une artériogra-phie diagnostique controlatérale (artère iliaque interne) et homolatérale (branches de l'aorte et de l'artère iliaque externe) ; • les lésions des gros troncs artériels et veineux sont rares, associées à une mortalité élevée, et relèvent d'une prise en charge spécifique (ballon d'occlusion le long de la plaie/packing en sandwich en l'attente de la réparation ou d'un pontage, endoprothèse couverte) [50,51] ; • une cible identifiée dans le territoire obturateur doit faire pratiquer une angiographie iliaque externe à la recherche d'une artère corona mortis si l'angiographie iliaque interne est normale.…”

Section: Modalités D'embolisationunclassified