Injury - 2026-07-22 - Journal Article
External Iliac artery injury in severe pelvic ring trauma: Limb salvage or early hemipelvectomy? A case series.
Yang YJ, Lai CY, Tsai PJ, Chen IJ, Liu CH, Yu YH
Topics
Key Takeaway
In 5 patients with combined external iliac artery injury and pelvic ring fracture, limb salvage failed in 100% of cases despite revascularization attempts in 2, with 4 of 5 ultimately requiring hemipelvectomy due to progressive necrosis and infection.
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Summary
This single-institution retrospective case series examined outcomes of combined external iliac artery injury and pelvic ring fracture in 5 high-energy trauma patients. Revascularization was attempted in 2 patients; limb salvage failed in all 5. Four patients required hemipelvectomy for progressive necrosis and sepsis; all 5 survived after prolonged multidisciplinary care.
Key Limitation
With only 5 patients, no objective threshold criteria (e.g., ischemia duration, soft-tissue zone of injury, contamination grade) for abandoning limb salvage can be derived or validated.
Original Abstract
PURPOSE
External iliac artery (EIA) injury associated with pelvic ring injury (PRI) is rare but represents a particularly devastating pattern of pelvic trauma, combining life-threatening hemorrhage and critical limb ischemia. Although vascular reconstruction is generally recommended, limb salvage may be unrealistic when severe soft-tissue destruction and contamination coexist. Guidance on abandoning salvage attempts and proceeding to early amputation or hemipelvectomy remains limited.
METHODS
We reviewed our institutional experience with patients sustaining combined PRI and EIA injury between 2013 and 2026. The injury characteristics, treatment strategies, and outcomes were analyzed. The severity of vascular injury, limb ischemia status, and pelvic fracture patterns were classified using established systems. Management decisions were examined within a staged surgical strategy focusing on damage control, stabilization, and reconstruction.
RESULTS
Five patients with high-energy trauma were identified. All patients had severe EIA injuries associated with major soft-tissue damage. Revascularization was attempted in two patients, but limb salvage was unsuccessful in all 5 cases. Despite repeated debridement, four patients ultimately required hemipelvectomy following progressive necrosis and infection. All patients survived after prolonged multidisciplinary treatment.
CONCLUSION
Combined EIA injury and PRI represents an extreme form of pelvic trauma in which vascular patency alone does not ensure limb survival. When severe soft-tissue destruction is present, prolonged salvage attempts may only delay definitive management. Early recognition of a non-salvageable limb and consideration of timely hemipelvectomy may be important in selected patients.