External iliac artery occlusion due to pelvic fracture: management with a cross-femoral bypass graft.

Vascular injury is not uncommon in cases of major pelvic trauma. Venous injury is by far the most common associated problem and may lead to exsanguinating hemorrhage. Arterial injury is less common, but certainly not without associated morbidity and mortality. It can lead to persistent bleeding after fixation and stabilization of the pelvic girdle, and occlusion of major pelvic arteries can cause limb ischemia and limb loss. The potential problems with revascularizing the ischemic extremity are (1) other life-threatening injuries that may be present and (2) a retroperitoneal hematoma that can interfere with an anatomic approach. Our solution to the latter problem, as presented here, is placement of a cross-femoral bypass graft, which rapidly and safely restores blood flow in the presence of pelvic fracture and an occluded external iliac artery. The pelvic hematoma is avoided, thereby restoring circulation more quickly, with less blood loss and greater ease.