In Reply to: Case 997_06 -- Pelvic pseudoaneurysm embolization posted by Editor on September 16, 1997 at 10:56:33:
Pelvic embolizations can be a life saving procedure. In pelvic trauma, should evaluate the plain films of the pelvis and select the side contalateral tothe most injury so theat a over the horn approach can be utilized to catheterize the internal iliac. Cobra is a good catheter with a Waltman loop for the ipsilateral side. In a hemodyanamically unstable patient, time is crucial and I do not hesitate to embolize the entire internal iliac circulation from a proximal position with gelfoam slurry followed by torpedoes or large pledgets. I try to avoid using permanent agents such as gelfoam or coils if at all possible .
In the coagulopathic patient, autologous clot stabilized with amicar and thrombin is extremely helpful to top off the artery in those situations where gelfoam alone is insufficient to control the hemorrhage.
There still seems to be a significant amount of controversy over embolizing the posterior division of the internal iliac. Although there is supply to the sciatic artery from the superior gluteal and there have been reports of sciatica or necrosis after embolization of the posterior division, these embolizations were done with gelfoam powder or alchol. Using large size gelfoam slurry and torpedoes, I don't think that there is any problem with embolization of the superior gluteal and rarely do I make any efforts to protect this divison when performing internal iliac embolization.