A single-center 5-year experience of iatrogenic vascular injuries and their outcomes

Abstract

Introduction: Diagnostic and therapeutic interventions can lead to iatrogenic vascular injuries (IVIs). The spectrum of IVIs, their management, and outcomes is presented. Materials and Methods: This prospective observational study from January 2016 to December 2020, included all successive IVIs managed by the vascular surgery department. IVI was defined as vascular injury manifesting as hemorrhage/vessel occlusion/and/or retained foreign body in vasculature. Those due to trauma and/or <30 days follow-up were excluded. Reasons for IVI, presentation, vessels involved, and outcomes were analyzed. Results: Thirty-eight IVIs were analyzed. Age ranged from 3 days to 77 years. Sixteen were due to cardiology, seven due to orthopedics, four cases in end-stage kidney patients, 4 cases due to invasive arterial monitoring, and two following cardiac surgery. One case each was following laparoscopy, spine surgery, thrombectomy, endovascular aneurysm repair, and umbilical catheterization. Manifestations were limb ischemia (lower limb-13, upper limb-6), pseudoaneurysms-10, retained foreign body-4 (superior vena cava and/or right atrium-3; external iliac artery-1), hemorrhage-2, arterio-venous fistula-2, and compartment syndrome-1. Common femoral artery (with/without superficial femoral artery) was affected in 13, forearm arteries in 8, popliteal artery and crural arteries in three each, and one case, each of profunda femoris, carotid artery, external iliac artery branch, and thoracic aorta. IVIs were managed by thrombectomy in 13, arterial repair in 11, endovascular procedures in 5, bypass in 4, conservative in 3, and by laparotomy and open retrieval of a balloon in one case each. Four developed surgical site infections, three died, three suffered amputations, three had motor deficits, and two developed acute kidney injury. Conclusion: IVIs have heterogeneous presentation. Both open and endovascular skill sets are required for management. IVIs carry high morbidity and mortality.