Stent-Graft Placement for the Management of Iliac Artery Hemorrhage in Patients With Pelvic Malignancy: Clinical Outcomes and Patency

PURPOSE: To evaluate clinical outcomes and patency of endovascular stent-graft placement for iliac artery hemorrhage in patients with pelvic malignancy. METHODS: We retrospectively reviewed 15 patients (21 cases) with pelvic malignancy undergoing emergency stent-graft placement for iliac artery hemorrhage from December 2011 to April 2025. Technical and clinical success, complications, primary patency, rebleeding rates, and survival were analyzed. Risk factors for rebleeding, specifically the degree of tumor invasion (encasement vs abutment), were assessed. RESULTS: Technical and clinical success were 100%. Significant hemodynamic improvements were achieved: systolic blood pressure (85.5±32.8 vs 114.8±15.7 mmHg; p=0.014), and heart rate (110.7±24.0 vs 93.7±15.9 bpm; p=0.037). During a mean follow-up of 11.5 months, rebleeding occurred in 6 cases (28.6%). Tumor encasement was associated with a numerically higher rebleeding rate compared with abutment (40.0% vs 0%; p=0.123). Cumulative 1-year primary patency and survival rates were 82.9% and 52.5%, respectively. CONCLUSION: Stent-graft placement appears to be a feasible and potentially effective approach for immediate hemostasis in iliac artery hemorrhage associated with pelvic malignancy. However, careful surveillance is warranted due to a clinically notable risk of rebleeding, particularly in cases with tumor encasement.Clinical ImpactStent-graft placement offers a reliable, vessel-preserving endovascular option for achieving immediate hemostasis in catastrophic iliac artery hemorrhage associated with pelvic malignancy. This study demonstrates excellent technical and clinical success while identifying progressive tumor encasement as a potential marker for delayed hemorrhagic recurrence. These findings may help clinicians stratify rebleeding risk and tailor post-procedural surveillance according to the degree of tumor-vessel involvement. In cases of recurrent hemorrhage despite repeated stent-graft placement, collateral circulation should be carefully assessed, as therapeutic arterial sacrifice with coil embolization may represent an effective salvage strategy. This study provides practical guidance for managing a rare but life-threatening clinical condition.