External Iliac Vein Injury During Acetabular ORIF: Endovascular Rescue in Orthopaedic Trauma and Review of Surgical Considerations

BackgroundMajor vascular injuries during orthopedic procedures such as open reduction and internal fixation (ORIF) of acetabular fractures are rare but potentially fatal. The iliac veins are particularly vulnerable during anterior approaches due to their close proximity to the pelvic brim.PurposeTo describe the management of an iatrogenic external iliac vein injury sustained during acetabular ORIF via a modified Stoppa approach and to highlight the role of endovascular techniques as a rescue strategy.Research DesignDescriptive case study and literature review.Study SampleSingle patient undergoing acetabular ORIF complicated by intraoperative external iliac vein injury.Data Collection and/or AnalysisIntraoperative findings, management strategy, and postoperative outcomes were systematically documented. A narrative review of the contemporary literature on endovascular management of iliac and inferior vena cava injuries was performed.ResultsThe injury resulted in sudden, massive hemorrhage that could not be controlled through open exposure due to limited visualization and significant bleeding risk. An intraoperative endovascular approach was therefore adopted. Sequential deployment of aortic cuff stent-grafts via femoral access achieved rapid hemostasis while preserving venous patency. Postoperative imaging confirmed patent stents without evidence of extravasation.ConclusionsEndovascular stent grafting represents a viable and potentially life-saving alternative to open repair for major iliac venous injuries, particularly in anatomically challenging settings. This paper demonstrates the importance of preoperative vascular preparedness and the integration of endovascular rescue strategies into orthopedic trauma surgery.