In this case, we showed that vascular imaging
might be better not only before the procedure but also
after the procedure in areas with dense collaterals.
Endovascular intervention was not performed as there
was no coil at our hospital at the time of the patient's
admission; however, if the coil had been made from the
proximal lateral circumflex artery, it would not have
been successful due to bleeding from the iliolumbar
artery.
The gluteal area has complex anatomical
characteristics. This morphology is associated with
the likelihood of pelvic or abdominal penetration
following gluteal injury. Penetrating injuries account
for up to 90% of vascular injuries, and vascular
injuries often occur between the ages of 20 and 40.[4,5]
Surgical exploration and repair are carried out as fast
as feasible in individuals with “hard” symptoms of
vascular injury, such as refractive hypotension and
apparent limb ischemia. Moreover, the authors advise
that CTA should be confirmed with DSA if the
CTA is not sufficient at the time of the accident with
suspicion of heavy vascular injury.[6] At the discretion
of the surgeon, arteriography can be conducted
preoperatively.[7,8] Only 12 patients undergoing
interventional radiology treatment were utilized to
control bleeding or target ballot in 12 individuals
as the sole method in the systematic review.[7,8]
Laparotomy and prolonged gluteal operation were
conducted in 207 (33.7%) subgroup patients out of
615 individuals with gunshot or stab trauma.[7,8]
The LCA is the biggest branch of the deep femoral
artery. It is 1.5 cm from the origin of the CFA in 67%
of the instances and is directly derived by the CFA
in 14 to 20%.[9] The iliac branch of the IIA travels
laterally into the iliac fossa to supply the iliac muscle
and the iliac bone. This branch also forms anastomoses
with iliac branches of the obturator artery, the deep
circumflex iliac artery, the LCA, and the superior
gluteal artery.[9] In addition, the modern techniques
including angiographic imaging accompanied by internal balloon occlusion provided us the opportunity
to localize bleeding source. After the detection of
the bleeding source, we had an opportunity to guide
re-operation procedure and appropriate management.
In conclusion, successful initial surgical ligation
with DSA guidance may not be sufficient in the dense
collateral region, particularly in a group of patients
with vascular injury, in which there is no standard
recommendation after the surgery. Reimaging might
be necessary for detailed bleeding control after the
procedure in case of suspicion.
Patient Consent for Publication: A written informed
consent was obtained from the patient.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Idea/concept: A.K., M.T., B.K.;
Design: A.K., M.T.; Control/supervision, data collection
and/or processing: A.K., M.T., E.Y.; Analysis and/or
interpretation, literature review: A.K., B.K., E.Y.; Writing
the article, critical review: A.K., M.T., T.Ö.; References and
fundings: A.K., E.Y., T.Ö.; Materials: A.K., M.T., B.K.;
Other: A.K., M.T., T.Ö.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.