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Vascular and Interventional Radiology

E2327. Pain In the Butt: Imaging and Endovascular Management of Pelvic Vascular Trauma

Capiro N1,  Phyu W2,  Park J1,2,  Chang M2,  Lee H.1,2 1. University of California, Los Angeles, Los Angeles, CA; 2. West Los Angeles VA Medical Center, Los Angeles, CA

Address correspondence to J. Park (jonathan.park09@gmail.com)

Background Information: Pelvic traumatic or iatrogenic pseudoaneurysms may manifest as painful and pulsatile masses, typically the result of blunt or penetrating vascular trauma. Arteriovenous fistulas, while rare, may also occur in a traumatic setting. Because these pathologies can be fatal, it is important to maintain their diagnostic possibility with patients who have had prior history of trauma to the relative area along with complaints of pain, nerve compression, and loss of mobility in the corresponding limb. We present an exhibit of patients with large pseudoaneurysms and arteriovenous fistulas arising secondary to traumatic and iatrogenic causes, with the aim of reviewing the diagnostic imaging and subsequent successful interventional endovascular management.

Educational Goals/Teaching Points: Traumatic and iatrogenic pelvic pseudoaneurysms and fistulas are rare and presentation may be confusing, but diagnosis is critical because of potential for fatal pathology. The aims of this exhibit are to review the presentations and various modalities of diagnostic imaging of traumatic and iatrogenic pelvic pseudoaneurysms and arteriovenous fistulas, as illustrated through real life case examples; and to guide the reader through the successful endovascular management techniques for these cases.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We present a pictorial review of anatomy, pathophysiology, and diagnostic imaging of pelvic pseudoaneurysm and fistula; graphic and radiographic guide to endovascular management; and visual overview of outcomes and complications.

Conclusion: Pelvic traumatic and iatrogenic pseudoaneurysms and arteriovenous fistulas are relatively rare. While these can be asymptomatic, and can be discovered incidentally, they can also present with significant morbidity and even death. Dedicated thorough imaging should be performed, and image-guided percutaneous biopsy should be avoided. Familiarity with various imaging modalities is required. Endovascular embolization is a proven and effective technique to manage these types of vascular pathologies.