Transradial Endovascular Treatment of Acute External Iliac Artery Rupture in Hemorrhagic Shock

Iliac artery rupture is a rare but life-threatening complication of transfemoral vascular procedures that typically requires urgent intervention. Traditional approaches use transfemoral or transbrachial access; however, transradial access may offer a safer alternative in selected patients. We report the case of a 68-year-old man with ST-segment elevation myocardial infarction and shock who underwent primary percutaneous coronary intervention via right radial access with intra-aortic balloon pump (IABP) support through the right femoral artery. Following staged coronary intervention and IABP removal, he developed profound hemorrhagic shock and cardiac arrest, raising suspicion for retroperitoneal hemorrhage secondary to iliac artery injury. A 6-Fr, 119-cm sheath was advanced from the left radial artery to the right common iliac artery, demonstrating active extravasation from the right external iliac artery. A 7 × 59-mm covered stent was successfully deployed, resulting in immediate cessation of bleeding and rapid hemodynamic improvement. This case demonstrates the feasibility of transradial endovascular treatment of acute external iliac artery rupture in hemorrhagic shock and highlights its potential as a bailout strategy. Clinical Impact This case expands the potential role of transradial access in the management of life-threatening iliofemoral vascular complications. The availability of long-shaft, low-profile peripheral devices now enables covered-stent delivery from the radial artery to the iliac circulation. Clinicians performing large-bore transfemoral procedures should consider transradial access as an alternative bailout strategy for the management of iliofemoral vascular complications when anatomy, equipment availability, and operator experience permit.