Transcatheter Arterial Embolization for Pelvic Fractures May Potentially Cause a Triad of Sequela: Gluteal Necrosis, Rectal Necrosis, and Lower Limb Paresis

Pelvic trauma and vascular emergencies

“…This may be responsible for acute lower limb ischemia [59]; • Adamkiewicz's artery, possible as a result of embolization of the lumbar artery or of an ilio-lumbar or a lateral sacral artery, which has vertical anastamoses with the lumbar arteries. This may cause spinal cord arterial ischemia [59].…”

“…• sciatic nerve paralysis due to embolization of either the lateral sacral artery (radicular arterial branches) or of the sciatic nerve artery feeding the nerve trunk and arising from the inferior gluteal artery [54]; • crural nerve paralysis by embolization of the ilio-lumbar artery (radicular and trunk branches) [54]; • muscle necrosis with necrotizing cellulitis due to embolization of parietal arteries (gluteal arteries) [55,56]; • bladder, uterine or rectal wall necrosis due to embolization of the visceral arteries (superior or inferior vesicle arteries, uterine arteries, middle rectal arteries) [57][58][59].…”

Traumatisme du pelvis et urgences vasculaires

“…• une paralysie sciatique, par embolisation soit de l'artère sacrée latérale (branches artérielles radiculaires), soit de l'artère du nerf sciatique à destinée tronculaire, issue de l'artère glutéale inférieure [54] ; • une paralysie crurale, par embolisation de l'artère iliolombaire (branches radiculaires et tronculaires) [54] ; • une nécrose musculaire, avec dermo-hypodermite nécro-sante, par embolisation des artères pariétales (artères glutéales) [55,56] ; • une nécrose pariétale vésicale, utérine ou rectale par embolisation des artères viscérales (artères vésicales supérieures ou inférieures, artères utérines, artères rectales moyennes) [57][58][59].…”

Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

“…Gluteal muscle necrosis after proximal embolization at the internal iliac artery level is most frequently reported, and its estimated incidence is about 6% (7,8,(10)(11)(12)(13). Surgical wound break down (12), pelvic organ infarction, including colon, ileum, ureter, and rectum (7,9), and neurologic complications, such as lower limb paresis, sacral plexus palsy, and sciatic palsy (9), have also been reported. Such complications could require additional surgical procedures, longer hospitalization, and lead to unexpected results, thus negatively impacting the trauma patient's outcome.…”

“…Although TAE is one of the most useful modalities for con- ma, it may be associated with various complications, including puncture site hematoma, impotence, iliofemoral embolization, paraparesis, and ischemic necrosis of the bladder wall, gluteal skin, femoral head, gluteal muscle, and colon (6)(7)(8)(9)(10)(11)(12)(13). Super-selective catheterization of injured vessels may be a good option for avoiding complications related to TAE, because the blood flow to adjacent structures can be maintained by selectively embolizing only the injured vessel.…”