Surgical Management of Iatrogenic Vascular Injuries

Abstract

Objective: latrogenic vascular injury is an abnormal state that occurs in patients as a result of inadvertent or erroneous treatment by physicians or surgeons. We describe our 10 year experience with patients who underwent surgical repair of iatrogenic vascular injuries after catheterization or operation. Methodology: Thirty one patients with iatrogenic vascular injury incurred between February 2001 and February 2011 who were surgically managed in our Department were reviewed retrospectively. The clinical presentation, localization and type of vascular injury were each analyzed. Results: This study group consisted of 19 males and 12 females, ranging in age from 16 to 69 years with an average age of 47.8 years. Of the 31 iatrogenic vascular injuries, 19 resulted from a percutaneous procedure and 12 were sustained intraoperatively. The intraoperative iatrogenic injuries affected the inferior vena cava in three patients, left renal vein in one, external iliac artery in four, common carotid artery in three, and internal carotid artery in one. Eleven patients associated with catheterization were operated on immediately. The remaining eight were operated on an elective surgical basis (Pseudoaneurysm or arteriovenous fistula). All patients made an uneventful recovery. Conclusion: Although experience and thorough knowledge of the vascular anatomy can prevent many potential iatrogenic vascular injuries, the risk of iatrogenic vascular injury cannot be completely eliminated. Therefore, we recommend that major operations requiring dissection in proximity to the vascular structures, and catheter based diagnostic or therapeutic procedures should be performed only in hospitals with an established vascular surgery department.