Endovascular Solutions for Iliac and Lower Extremity Junctional Injuries

Abstract

Hemorrhage is the second leading cause of death in trauma and non-compressible torso hemorrhage is the leading cause of preventable death within this population. Vascular injuries to the pelvis and lower extremity junctional zone may be difficult to control with direct pressure and complex to approach with open surgery. Endovascular interventions such as balloon occlusion, stenting and embolization are potential alternatives or adjuncts to traditional open surgery in patients with blunt or penetrating vascular injuries to the pelvis. This review of the literature will outline contemporary endovascular management strategies for iliac and junctional zone injuries.

Direct site endovascular repair as salvage procedure after anastomotic breakdown of primary repair following trauma

“…To accomplish this bridge, the stent grafts rely on outward radial force over a landing zone of healthy vessel on either side of the spanned arterial segment. The successful use of stent graft arterial repair in trauma has been previously documented for pseudoaneurysms in locations that are normally difficult to access with conventional open approach 6, 7, 8. Similar open hybrid approaches have also been previously used in mesenteric arteries as surgical treatment of acute and chronic mesenteric ischemia 9, 10…”

Successfully Stifling Retroperitoneal and Pelvic Exsanguination by Resuscitative Endovascular Balloon Occlusion of the Aorta in a Rural Setting

“…The use of REBOA is controversial, however. Patients who qualify for REBOA must be selected judiciously as its negative effects may outweigh the benefit of hemostasis [5,6]. We present a case of a highly successful pelvic trauma recovery following a zone 3 (Figure 1) REBOA insertion.…”