Isolated iliac vein injuries from blunt trauma are uncommon but potentially life‑threatening. We report a case of isolated left external iliac vein injury in a 39-year-old female patient following blunt trauma sustained in an electric scooter-related motor vehicle collision. Despite the absence of pelvic fractures, the patient presented with hypotension requiring massive hemorrhage protocol activation and vasopressor support. Computed tomography demonstrated a pelvic hematoma with active venous contrast extravasation. Diagnostic angiography was performed, but endovascular repair was not feasible due to the inability to advance the catheter through extensive venous thrombosis. The patient was subsequently managed conservatively with therapeutic anticoagulation initiated on hospital day 5, inferior vena cava (IVC) filter placement for pulmonary embolism prophylaxis given the contraindication to immediate anticoagulation, and supportive care, resulting in hemodynamic stabilization and clinical improvement. This case highlights that isolated iliac vein injuries can occur without pelvic fractures and emphasizes the need for early computed tomography angiography in hemodynamically unstable trauma patients with pelvic hematomas. When endovascular intervention is not technically feasible, conservative management with individualized timing of anticoagulation and selective IVC filter placement can achieve favourable outcomes in appropriately selected patients.
Alnuaimi et al. (Wed,) studied this question.