selective angiogram of the left common femoral artery (c, d) shows a large contrast blob (pseudoaneurysm) in the distal part of the supercial femoral artery. Post-vascular reconstruction (stent graft) images (d) demonstrate complete occlusion of the pseudoaneurysm with preserved forward ow

artery-related injuries. USG guidance when available is pref­erable, especially in cases with hemodynamic instability. Heparin and heparin saline should be withheld in the setting of acute trauma. A selective angiogram is performed using a catheter like Picard or vertebral catheter. Cross-over sheath or long sheath is used when stent grafting is used, to stabilize the hardware if the injury is located distally. The long sheath is used for upper limb arterial injury, to stabilize the hard­ware and place stent graft.

Superselective catheterization of the targeted artery is usually done with a microcatheter. Depending upon the imaging and angiographic injury pattern, embolization or vascular reconstruction is done. In case of focal active bleed­ing or pseudoaneurysm or large AV stula, with an appropri­ate landing zone in the sacricable artery, proximal embolization is done using permanent embolizing agents like coils or coils with glue or plug, aimed to complete blockage of the forward ow of the targeted artery. In case of focal active bleeding or pseudoaneurysm or AV stula, with an appropriate landing zone in the main artery or non­sacricable artery, vascular reconstruction is done using a stent graft, aimed to salvage the limb and vessels, to achieve hemostasis.

ologist. However, the contralateral site or site opposite of pelvic fracture is used for puncture, for ease, and to allow more secure seating of the catheter. USG guidance when available is preferable, especially in cases with hemody­namic instability and given pelvic binder, that can be cut away to create a sufcient window. Heparin and hep saline should be withheld in the setting of acute trauma. A selective external iliac and common femoral artery angiogram is per­formed using appropriately shaped catheters like Picard or Simmons reverse curve (SIM1) depending on the angle of aortic bifurcation, and usually contralateral angiogram is preferred (if suspected), followed by ipsilateral. Superselective catheterization of the targeted artery is done with a microcatheter. The angiographic evidence of arterial injury is spasm, truncation of the artery (cut-off sign), extrav­asation, pseudoaneurysm, and AV stula formation. Oblique view and delayed images are taken until venous return. Always look for multiple bleeder sites and the primary aim is to manage the massive bleeder site rst and embolize as selectively as time permits. A tailored approach is essential for optimizing patient outcomes and minimizing potential complications. Selective embolization is the preferred method if patient hemodynamics are stable as it minimizes damage to the noninjured vessel, but this can be technically

Selective angiogram of the right maxillary artery (c) shows contrast blush (extravasation) from the facial branch of the right internal maxil­lary artery in the distalmost part, which could not be reached due to the small caliber of the vessel. Therefore, gelfoam embolization was per­formed. Post-coil embolization images (d) demonstrate complete occlusion without further extravasation

Complications are rare and primarily associated with access sites, as well as complications secondary to embolization­related issues, such as nontarget embolization and local isch­emic changes or soft tissue swelling [44]. Other uncommon complications include cerebrovascular accidents, blindness, lip-tongue necrosis, facial nerve palsy, and trismus [45].