الفهرس 
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Abstract
The diagnosis of arterial trauma may be established by DSA or noninvasive (ultrasonography, followed by CT and/or MRI when indicated) means.
Suspicion of arterial injury is usually based on the findings of clinical examination. Careful evaluation can detect abnormalities in patients with major arterial injuries. But it is known that arterial injuries may present with so-called ‘‘soft’’ signs (stable hematoma, adjacent nerve injury, unexplained hypotension, or proximity of the penetrating wound to the underlying major blood vessels) and may be overlooked. Because occult injuries are not uncommon, the routine use of arteriography is advocated when there is a wound in the proximity of important vessels [189, 190].
Traumatic vascular injuries can result in serious delayed complications, and these may occur even years later if they are not identified. Patients with traumatic injuries must be closely monitored, and arteriography is recommended to evaluate their condition with regard to a potential vascular injury, even if overt clinical signs or symptoms of vascular injury are absent.[191] The placement of occluding balloons to control bleeding, the initial treatment method for vascular surgery, has been widely reported.[192] Additionally, the recent development and application of endovascular technology and therapy has led to the use of stent grafts in the management of arterial injuries.[193] Currently, stent graft implantation or coil embolization are considered to be the optimal methods of treatment for pseudoaneurysms or uncontrollable
bleeding.[194]
In this study, in five patients the diagnosis of arterial injury was not suspected at the first presentation and was established later when the symptoms persisted.
Balloon control was done to tow patient in our study one of them done after rapid disturbance of general condition of the patient during ballon dilation of rt common iliac artery in form of thready pulse and sweatness and hypotension with extravasation in arteriography, rapid control save the life of the patient and gave time for surgical repair, the second one done to the lt subclavian artery pseudoaneurysm befor surgical repair to decrease the risk of bleeding.
Embolization was done to the rest of the patients, where exposure was difficult, the injured vessel was minor vessel, not accessible and with high risk of bleeding as in the patients with retroperitoneal hematomas, or with high risk of contamination to the underlying procedures if surgical evacuation was done to hematomas with inaccessible bleeders to tow patients.
The modern therapeutic management of patients with serious pelvic fractures is based largely on techniques for rapidly stopping bleeding. In haemodynamically unstable patients, the frequency of pelvic bleeding of arterial origin is high, and angiography with arterial embolization is therefore the treatment of choice. If haemodynamic conditions permit, embolization should be preceded by whole-body CT scans, making it possible to screen for extrapelvic arterial injury, to localize the pelvic bleeding and to guide embolization to facilitate the rapid, selective catheterization of the arteries most likely to be damaged. Arterial embolization can be carried out immediately, or as a secondary treatment, in cases of persistent or recurrent bleeding with haemodynamic instability. Pelvic fixation devices, which are thought to facilitate venous haemostasis, could be used as a complement to arterial embolization.195