OTA 1997 Posters - Pelvic & Acetabular Fractures

Common Iliac Artery Injuries Associated with Pelvic Fractures

Eddy H. Carrillo, MD, David A. Spain, MD, Frank B. Miller, MD, J. David Richardson, MD

University of Louisville, Louisville, Kentucky, USA

Purpose: Common iliac artery injury associated with pelvic fractures is uncommon. The diagnosis of such injuries is based on clinical suspicion, the presence of bruits, and pulse changes or discrepancy in the lower extremities. The vascular injury may not manifest itself initially but result in thrombosis, subintimal hemorrhage, dissection or aneurysmal dilatation. Eventually, these can result in hemorrhage, pain, or ischemia in the ipsilateral extremity.

Methods: We report 5 cases of blunt injuries to the common iliac artery associated with pelvic fractures.

Results: There were 3 men and 2 women, aged 14 to 68 years (average 34 years). All were involved in high speed motor vehicle crashes, and all had associated pelvic fractures. Four injuries occurred in the right side and 1 in the left side. In 2 patients there was an associated pelvic hemiluxation (Malgaigne's fracture) on the right side. Four patients with intimal injuries and subsequent thrombosis, were diagnosed in the first 6 hrs after admission, 2 with cadaveric extremities and 2 with absent femoral pulses. One patient presented 2 months after his original injury, complaining of increasing pain, and numbness in the right lower extremity. On physical examination, a pulsatile mass and a bruit were found in the right lower quadrant, and a subsequent arteriogram demonstrated a false aneurysm of the right common iliac artery. All patients underwent repair with a PTFE interposition graft, 3 through a transabdominal approach, 1 through an extraperitoneal approach, and 1 underwent a femoro-femoral suprapubic cross-over. One patient underwent a high amputation of the right lower extremity after multiple attempts failed to reestablish perfusion, and 1 patient expired due to associated injuries, although significant hemorrhage during the arterial repair may have played a role in his final demise.

Conclusion: Shearing forces applied to the iliac vessels seem to be the most likely etiology of this uncommon injury associated with pelvic fractures. Pelvic hemiluxation may arise suspicion of this injury. Ideally, an extraperitoneal approach should be attempted to minimize blood losses, and due to the size and poor mobilization of the iliac vessels PTFE should be employed for reconstruction. The diagnosis of this injury is confirmed by a selective iliac arteriogram, and in the future, endovascular stenting of the intimal defect may be the alternative of choice.