Iliac Artery Injury
Damage to a major pelvic artery that supplies the legs
Quick Facts
- Type: Major vascular injury (emergency)
- Common causes: Pelvic fracture, penetrating trauma, surgery
- Main risks: Heavy bleeding, loss of blood flow to the leg
- Action: Call emergency services immediately
Overview
The iliac arteries are large blood vessels in the pelvis that branch from the main artery of the body (the aorta) and carry blood to the legs and pelvic organs. An iliac artery injury is damage to one of these vessels. Because they carry a large volume of blood under high pressure, an injury can cause rapid, life-threatening internal bleeding, or it can block blood flow and threaten the leg.
Iliac artery injuries most often result from severe pelvic trauma, penetrating wounds, or as a rare complication of pelvic surgery or vascular procedures. This is a medical emergency, and anyone with signs of heavy internal bleeding after a pelvic injury needs immediate care.
Symptoms
Signs of an iliac artery injury reflect blood loss, blocked blood flow, or both:
- Severe pelvic or abdominal pain
- Swelling or a pulsating mass in the lower abdomen or groin
- Pale, cold, or numb leg with weak or absent pulses
- Dizziness, pale skin, sweating, rapid heartbeat, or fainting (signs of shock)
- Low blood pressure
- External bleeding from a wound in the groin or lower abdomen
These are emergency signs. Rapid internal bleeding can be fatal within a short time, so call emergency services without delay.
Causes
Iliac artery injuries result from force, sharp objects, or procedures affecting the pelvis. Common causes include:
- Pelvic fractures: Bone fragments from severe pelvic trauma can tear the artery.
- Penetrating trauma: Stab and gunshot wounds.
- Surgical or procedural injury: Pelvic, spinal, or vascular procedures can rarely damage the vessel.
- Crush injuries: Severe compression of the pelvis.
Because these vessels lie deep in the pelvis near other organs and the major veins, injury is often accompanied by other serious damage.
Risk Factors
- High-energy pelvic trauma and pelvic fractures
- Penetrating abdominal or pelvic wounds
- Pelvic, spinal, or vascular surgery
- Weakened or diseased blood vessels
- Crush injuries to the trunk
Diagnosis
Because the situation is often urgent, diagnosis happens quickly:
- CT angiography: A scan with contrast dye that shows the arteries and where they are bleeding or blocked.
- Physical exam: Checking leg pulses, color, temperature, and signs of shock.
- Conventional angiography: An X-ray of the vessels that can also guide treatment.
- Bedside ultrasound and blood tests: To detect internal bleeding and assess blood loss.
In an unstable patient, treatment may begin immediately in the operating room or angiography suite based on the clinical picture.
Treatment
Treatment focuses on stopping bleeding and restoring blood flow as fast as possible.
- Resuscitation: Fluids and blood transfusions to treat shock.
- Endovascular treatment: Through a catheter, doctors can place a stent-graft to seal the artery or block a bleeding branch (embolization).
- Surgery: Open repair to fix the artery, sometimes using a graft to bridge the damaged section.
- Treating other injuries: Pelvic fractures and other damage are managed at the same time.
Prompt treatment greatly improves the chance of survival and of saving the affected leg.
Prevention
- Always wear a seatbelt and use protective equipment
- Follow safety rules around weapons and machinery
- Ensure pelvic and vascular procedures are done by experienced teams
- Seek immediate care after any severe pelvic injury
When to See a Doctor
An iliac artery injury is a life-threatening emergency. Call emergency services immediately after a pelvic injury if there are signs of:
- Heavy internal or external bleeding
- Dizziness, pale skin, sweating, rapid heartbeat, or fainting
- A cold, pale, numb, or pulseless leg
- Severe, sudden pelvic or abdominal pain
If there is visible bleeding from a wound, apply firm direct pressure while waiting for help. Every minute counts, so do not delay in seeking emergency care.
Frequently Asked Questions
Why is an iliac artery injury so dangerous?
The iliac arteries carry a large amount of blood under high pressure. An injury can cause rapid, life-threatening internal bleeding or cut off blood flow to the leg, so it is a medical emergency that needs immediate treatment.
What causes an iliac artery injury?
Most are caused by severe pelvic trauma with fractures, penetrating wounds such as stab or gunshot injuries, or, rarely, pelvic and vascular surgical procedures. Crush injuries to the pelvis can also damage the vessel.
How is an iliac artery injury treated?
Treatment starts with fluids and blood to treat shock, then stopping the bleeding. This may be done through a catheter with a stent-graft or by blocking a bleeding branch, or with open surgery to repair the artery, sometimes using a graft.
What are the warning signs?
Severe pelvic or abdominal pain, signs of shock such as dizziness, pale skin, and fainting, and a cold, pale, or pulseless leg are warning signs. Visible heavy bleeding from a wound is also an emergency.
What should I do while waiting for help?
Call emergency services immediately. If there is visible bleeding from a wound, apply firm, steady direct pressure with a clean cloth. Keep the person still and do not delay, as rapid blood loss can be fatal.
References
- American College of Surgeons. Vascular and Pelvic Trauma.
- Society for Vascular Surgery. Traumatic Vascular Injuries.
- MedlinePlus, U.S. National Library of Medicine. Vascular injury.
- National Heart, Lung, and Blood Institute (NHLBI). Bleeding and shock.