Surgical Approaches to Iatrogenic Vascular Injuries in Adults

INTRODUCTION: Surgical procedures can result in unforeseen vascular injuries. In cases of severe vascular injuries, the involvement of an experienced vascular surgeon in the operation can be life-saving. The aim of this study is to elucidate the surgical approaches and outcomes in vascular injuries that occurred during elective operations of various branches within our institution.
METHODS: Between April 2019 and October 2021, 18 patients required surgery due to unexpected severe vascular injuries. Gender, age, injury site, elective operation, intervention to vascular injury, hemodynamic status, type of anesthesia, mean operation time, and post-operative status of the patients were retrospectively obtained from hospital database. The intensive care unit and service follow-ups of the patients as well as their post-discharge controls were collected from hospital records.
RESULTS: Among the patients undergoing vascular intervention, 60% (n=11) experienced arterial injuries, while 40% (n=7) had venous injuries. When examining the type of intervention, all patients, except for one, underwent intervention by placing a side or cross-clamp on the vascular structure. Primary repair was performed in 11 patients, end-to-end repair in 2 patients, PTFE graft placement in 1 patient, saphenous vein interposition in 3 patients, and ligation in 1 patient. Two patients (11%) died during the surgery.
DISCUSSION AND CONCLUSION: As a result, the surgeon should accurately and quickly evaluate findings such as unexplained hypotension, tachycardia, loss of pulse or heat loss during the operation, and should suspect vascular injury. It is possible to reduce mortality and morbidity rates when iatrogenic vascular injuries are diagnosed early.