Iliac artery injuries and pelvic fractures: a national trauma database analysis of associated injuries and outcomes.

BACKGROUND: Although infrequent, injury to the common or external iliac artery in association with pelvic fractures can be devastating, and descriptive data are lacking. This study was performed to determine the incidence, injury patterns, and outcomes of blunt iliac artery injuries (BIAIs) in association with moderate or severe pelvic fractures.
METHODS: Patients with moderate or severe pelvic fractures (abbreviated injury score of 3 or 4) were identified from the National Trauma Databank. Records with and without common or external BIAI were compared. Admission variables included Emergency Department (ED) hypotension (systolic blood pressure <90), Glasgow Coma Score <or=8, Injury Severity Score (ISS) >or=25, femur or lumbosacral fractures, solid organ injury, vascular injury, and hollow viscus injury. The association of BIAI with moderate or severe pelvic fractures was studied. Outcomes were also analyzed, and independent associations with BIAI were determined by logistic regression.
RESULTS: Of 6,377 patients with moderate or severe pelvic fractures, 221 (3.5%) had an associated BIAI. Patients with BIAI were more likely to have ED hypotension, Glasgow Coma Score <or=8, ISS >or=25, genitourinary injury, bowel injury, and severe (abbreviated injury score 4) pelvic fractures. BIAI was also associated with higher mortality, lower extremity amputation, compartment syndrome, and overall complications. Independent risk factors for BIAI included severe pelvic fracture, ED hypotension, ISS >or=25, genitourinary injury, and bowel injury.
CONCLUSION: BIAI is a rare diagnosis, but when present it is associated with a higher rate of overall complications and mortality. Vigilance is warranted in the diagnosis and management of this infrequent injury, especially in the setting of severe pelvic fractures.