Complicated surgical reconstruction of a penetrating external iliac artery injury

Iliac vessel injuries often occur in conjunction with intra-abdominal trauma and can carry high rates of morbidity and mortality. We present the case of a 29-year-old man with a gunshot wound to the pelvis resulting in injury to the left external iliac artery, managed initially with temporary arterial shunting. Definitive repair was performed using a contralateral great saphenous vein interposition graft, followed by multiple reoperations for bowel injury and infection. The patient subsequently developed a pseudoaneurysm at the proximal anastomosis site of the interposition bypass, requiring urgent endovascular stenting for stabilization. A staged, right to left femorofemoral bypass was later performed using a prosthetic graft after debridement of the infected field. The patient was treated with prolonged antimicrobial therapy and percutaneous drainage of a postoperative abscess. This case illustrates the complexity of managing iliac artery trauma in the setting of concomitant bowel injury and infection, and highlights the utility of staged, hybrid vascular reconstruction in achieving durable outcomes. Further study is warranted to better define optimal strategies for infection control and graft selection in contaminated operative fields.