LAUSR

Bilateral ligation of the anterior division of the internal iliac arteries can be a life-saving intervention for severe pelvic hemorrhage. The procedure results in decreased pelvic perfusion and promotes coagulation. The classical method of internal iliac artery ligation involved extensive retroperitoneal dissection with complete circumferential isolation of the vessel to allow for passage of a suture around the artery. This can be surgically challenging and fraught with risk of inadvertent injury to the surrounding iliac veins. We propose a contemporary technique that requires limited dissection of the anterior division of the internal iliac artery. A few millimeters of space is created on either side of the artery by spreading a right-angle forceps parallel to the vessel. The artery is then occluded by two large vascular clips. Since circumferential vessel dissection is not necessary with this technique, there is limited disruption of the delicate underlying internal iliac vein. This approach may also decrease risk of inadvertent injury to the adjacent external iliac vein. By showcasing the ease of our approach to internal iliac artery ligation, we hope to empower surgeons with an alternative approach to this life-saving procedure.