title: Acute bilateral iliac artery occlusion secondary to blunt trauma: successful endovascular treatment.
abstract: BACKGROUND
  Endovascular treatment of blunt vascular trauma has been infrequently reported.
  
  
  METHODS
  A 27-year-old man was crushed between a fork-lift truck and a concrete platform. The physical examination was remarkable for hemodynamic stability, significant lower abdominal ecchymosis and tenderness, obvious pelvic fracture, and gross hematuria. Vascular examination revealed no femoral pulses, no pedal signals bilaterally, and minimal left leg and no right leg motor function. Arteriograms revealed right common iliac artery and external iliac artery occlusion and a 2-cm near occlusion of the left external iliac artery.
  
  
  METHODS
  In the operating room, bilateral common femoral artery access was obtained, and retrograde arteriogram on the right side demonstrated free extravasation of contrast material at the level of the proximal external iliac artery. An angled glide wire was successfully traversed over the vascular injury, and two covered stents (Wallgraft, 10 x 50 mm and 8 x 30 mm) were deployed. The left iliac injury was similarly treated with an 8 x 30-mm covered stent. After calf fasciotomy, exploratory laparotomy revealed a severe sigmoid colon degloving injury, requiring resection and colostomy. A suprapubic catheter was placed because of bladder rupture, and an open-book pelvic fracture was treated with external fixation. Postoperatively the patient regained palpable bilateral pedal pulses and normal left leg function, but right leg paralysis persisted secondary to severe lumbar plexus nerve injury.
  
  
  CONCLUSIONS
  Endovascular repair of blunt intra-abdominal arterial injuries is possible and should be particularly considered when fecal contamination, pelvic hematoma, or multiple associated injuries make conventional repair problematic.
authors.affiliation: Section of Vascular Surgery, Ochsner Clinc Foundation, New Orleans, LA 70121, USA. csternbergh@ochsner.org
authors.forename: W Charles
authors.initials: WC
authors.lastname: Sternbergh
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conners
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Ojeda
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Money
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007083:Iliac Artery; D015601:Injury Severity Score; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency; D014949:Wounds, Nonpenetrating / Q000150:complications