Abstract Hip arthroplasty, and particularly revision surgery, may be complicated by injury to the large vessels on rare occasions, and this can be responsible for severe sequelae. The potential for vascular damage is increased when acetabular osteolysis is followed by medial dislocation of the socket. We report preliminary experience in performing preoperative arteriography of the iliofemoral vessels in 15 patients affected with endopelvic protrusion of the acetabular component. Digital angiography was helpful in defining the precise relationship between the arteries and the prosthesis. When the cup revealed a close proximity to the major vascular structures (10 cases), revision hip surgery was preceded by a laparotomic approach to isolating pelvic vessels, thus permitting an immediate control of the potentially massive bleeding.