A young patient with a pelvic fracture hemorrhaging and hemorrhagic shock caused by a car accident recently – pelvic fracture, sacral fracture with incomplete paralysis, fracture of the right transverse process of lumbar 5, urethral injury, hemorrhagic shock, a series of medical diagnostic terms and the patient’s crisis state made the family completely dizzy. The estimated blood loss was over 3,000 ml, and the emergency physicians immediately performed fluid resuscitation, blood transfusions and related tests, and the patient was admitted to the intensive care unit (ICU) after his vital signs stabilized slightly. Sometimes life is so elusive. The patient’s vital signs were stable after he was admitted to the ICU, but the next day at noon, his condition suddenly changed – the patient’s urethra suddenly continued to spurt blood outward, just like a water pipe with a switch turned on, and the bleeding volume reached 500ml in 5 minutes. ”Pelvic fracture combined with hemorrhage, hemorrhagic shock, immediately notify the blood transfusion department to prepare blood, notify urology, orthopedics, vascular surgery, catheterization laboratory emergency consultation, and report to the hospital medical general duty.” The physician on duty made an immediate decision, and the staff of the department immediately carried out medical orders in an orderly manner. The hospital’s multidisciplinary (MDT) team of experts consulted the patient and concluded that the patient’s active bleeding had not stopped and the specific site was difficult to determine, so if effective measures could not be taken to stop the bleeding immediately, the patient’s life would be in danger. Dr. Zhao Yang of the catheterization laboratory, who was originally celebrating his daughter’s birthday, received the call and immediately rushed to the hospital to operate on the patient. Dr. Zhao was skilled in disinfection, towel laying, local anesthesia, arterial puncture, and contrast injection, but the patient continued to spill a large amount of contrast from the left internal iliac artery branch. At this time, the patient’s condition deteriorated due to continuous bleeding, and he became unconscious, his blood pressure plummeted, and his oxygen saturation dropped to 75%. The anesthesiologist immediately intubated the patient with tracheal intubation and ventilator treatment. Dr. Zhao quickly performed selective left internal iliac artery cannulation, injected embolic agent, and successfully stopped the bleeding with a one-time embolization! The patient’s life crisis was relieved once again, and he returned to the ward smoothly after observation. the next day, the patient was conscious, and the ventilator was evacuated and the tracheal intubation was removed. 5 days later, the patient showed no signs of rebleeding and was transferred to the orthopedic department for continued treatment. Pelvic fractures are most commonly seen in serious accidents such as motor vehicle traffic accidents, falls from height, mine or building collapses. The injuries are often very serious due to the tremendous external forces that cause them. Pelvic fractures combined with hemorrhage account for 15%-65% of pelvic fracture patients and are often quite dangerous, being one of the most important causes of early death from pelvic fractures, with a mortality rate of 50%-60%. The pelvic ring consists of the sacrum and the hip bones on both sides, mainly relying on the posterior sacroiliac ligament, the anterior sacroiliac ligament, the sacrospinous ligament, the sacral nodal ligament and the iliolumbar ligament to maintain stability, with no bony intrinsic stability structure, of which the strongest and most important is the posterior sacroiliac ligament. The pelvis contains important organs such as the bladder, large intestine and small intestine, as well as many important nerves and blood vessels. The blood supply of the pelvis mainly comes from the branches of the internal iliac artery, which can be divided into anterior and posterior trunks. The posterior trunk branches include the lateral sacral artery, the lumbar iliac artery, the superior gluteal artery, the inferior gluteal artery and the internal pubic artery; the anterior trunk branches include the umbilical artery, the inferior bladder artery, the inferior rectal artery, the vas deferens artery (or the ovarian uterine artery) and the occlusal artery. The bleeding site of pelvic fracture is mostly in the internal iliac artery and its branches. In the past, conservative treatment was used to stabilize the pelvis with large amounts of fluid and medical lap band, external fixation brace and C-clamp, hoping to achieve pelvic stability by “self-filling effect” to confine the exuded blood in a confined space, resulting in increased pelvic pressure to control bleeding. However, the effect of this treatment is limited, and the large amount of rehydration can cause disorders of acid-base balance in the body, and even cause heart and kidney failure, resulting in many complications, and the mortality rate is still high. Internal iliac artery ligation is a traditional surgical treatment, which can rapidly control bleeding because the collateral circulation of pelvic vessels is very rich, and the blood supply of pelvic organs will not be affected after ligation. Although internal iliac artery ligation has achieved certain efficacy, there are many disadvantages, such as the operation will open the posterior peritoneum, which will destroy the compression effect of the hematoma in the posterior peritoneum and easily aggravate the risk of bleeding; it is difficult to accurately determine the site of bleeding and whether there is bilateral or multiple bleeding before the operation; in addition, the operation itself is risky and has a long recovery time and many complications. Angiography was first used in 1972 as a clinical method to examine pelvic fractures with hemorrhage. Currently, angiography and embolization are the preferred treatment methods for pelvic fracture with hemorrhage. The advantages are: small trauma, accurate localization of hemorrhage, no disruption of peritoneal compression effect, short operation time, good hemostatic effect, and if other organs bleed at the same time, the diagnosis can be made by angiography and hemostatic treatment by embolization together. In general, the direct signs of pelvic fracture with arterial hemorrhage are spillage of contrast agent in the form of flakes, and the indirect signs include vascular disruption or intravascular thrombosis, irregular vascular tortuosity, and vasospasm. For interventional embolic substance selection includes: own clot, gelatin sponge, wire loop, etc. Fine bleeding can be embolized with medical gelatin sponge strips or granules. If the bleeding artery is the main stem of internal iliac artery, or its larger branches, the embolization must be combined with spring ring, otherwise the gelatin sponge alone will be washed away by the blood flow due to its small size and cannot achieve reliable hemostasis effect. The sign of successful embolization is the slowing down of blood flow in the embolized trunk artery and the disappearance of bleeding signs such as obstruction of the bleeding artery branch and spillage of contrast agent.