Management of iatrogenic superior gluteal artery injury post-bone marrow biopsy: A case report of successful endovascular balloon occlusion

Abstract

Iatrogenic vascular injury, particularly to the superior gluteal artery (SGA), though rare, represents a critical complication of bone marrow biopsy due to the artery's anatomical vulnerability during the procedure. This vulnerability can lead to life-threatening hemorrhage, retroperitoneal or gluteal hematomas, pseudoaneurysms, or compartment syndrome. The SGA's anatomy, which is not easily accessible via open surgery, makes endovascular therapy the preferred intervention. Temporary balloon occlusion is 1 endovascular option; it preserves collateral circulation, unlike permanent coils or stents, which carry risks of thrombosis or stenosis. Published literature supports endovascular approaches, demonstrating high success rates with fewer complications despite technical complexity. We report a case of a 41-year-old male with precursor B-cell lymphoblastic leukemia who sustained a rare SGA injury during a routine bone marrow biopsy at the posterior superior iliac crest and was successfully managed endovascularly.

Keywords: Balloon occlusion; Bone marrow biopsy; Endovascular therapy; Iatrogenic injury; Superior gluteal artery.

Fig. 1

(A) CTA was performed with the patient in the prone position, showing the trocar needle (white arrow) transversing the left sacral ala (white arrowhead). (B) The tip of the trocar needle (white arrowhead) was abutting a branch of left IIA (white arrow), with no significant arterial blush or hematoma visualized.

Fig. 2

(A) and (B) The patient was positioned in the right lateral decubitus position in angiography suite to ensure needle stability (white arrow).

Fig. 3

(A) Selective angiography showed the trocar needle (black arrowhead) abutting the left SGA (black arrow). (B) Selective angiography performed upon removal of the inner stylet of the trocar needle simultaneously revealed contrast leakage through the trocar needle (black arrow). (C) A 6 mm x 40 mm Mustang balloon (Boston Scientific, Marlborough, MA; black arrow) was placed across the injury site and inflated as the trocar (black arrowhead) was withdrawn. (D) Final angiography showed a patent left IIA (black arrowhead) without evidence of bleeding.