Figure 13.

Patient with massive bleeding after a gunshot wound to the pelvis initially treated with surgery. Following ligation of the right external iliac and left internal iliac (hypogastric) arteries, the patient continued with massive blood loss. (A) Digital subtraction angiogram pelvic angiogram. Delay image shows a stump of the left hypogastric (arrow); reconstitution of the left hypogastric is seen with a pseudoaneurysm (PSA; curve arrow). (B) Digital subtraction pelvic angiogram shows a stent graft placed over the stump of the left hypogastric; there is persistent filling of the PSA though collaterals. (C) Radiograph shows retrograde filling involving distal collaterals from the circumflex femoral artery into the area of PSA. (D) Digital subtraction angiogram shows multiple microcoils placed distal and proximal to the lesion. (E) Pelvic angiogram after the embolization shows successful exclusion of the PSA. (Case courtesy of Arturo Gonzalez, M.D., LSU, Lafayette, LA.)