Fig. 5

Axial CT of a stable patient with a fracture of the left pubic ramus (circled in A) and pelvic hematoma (circled in B). Proximal non-subtracted angiogram of the left external iliac artery (C) showing no focal “blush”. The subsequent selective study of the left internal obturator artery demonstrating the contrast blush [circled in subtracted image (D)] in correspondence consistent with injury lesions on CT and suitable for superselective embolization; digital subtracted image of the same patient, allowing a more accurate depiction of the arterial extravasation (circled in E). Selective catheterization of the injured artery (F). The arterial branch responsible for the blush was embolized with Glue, a definitive embolic agent (head arrow in G) while the upper obturator branch that supplies external genitalia is closed with Spongel, an absorbable embolic material (arrow in G). Compared to the pre-procedural angiography in which are highlighted the vessel (red points in H) responsible for bleeding (circled in H), the post-embolization angiogram confirms a successful occlusion only of the injured artery (arrow in I) with the regular patency of the remaining vessels