Elektif Abdominal ve Pelvik Cerrahi Esnasında İatrojenik Vasküler Yaralanmalar: Retrospektif, Tek Merkez, 30 Günlük Takip SonuçlarıMehmet Ali Yesiltas, Yasar Gokkurt, Serkan Ketenciler, Cihan Yucel, Melek Yilmaz, Ilhan Ozgol, Mehmet Kursat Kurt, Seran GulbudakDr. Cemil Taşçıoğlu Şehir Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul
Giriş: Nadir de olsa elektif karın veya pelvik ameliyatlarda damar yaralanmalarıyla karşılaşılmaktadır. İlgili arter/vende herhangi bir yaralanma olduğunda, bu durum hem kısa hem de uzun vadede mortalite ve morbidite ile ilişkilidir. Elektif olgularda damar yaralanmalarında tedavi yaklaşımımızı ve kısa dönem sonuçlarımızı paylaşmayı amaçladık.
Method: Bu çalışmada Ocak 2018 ile Temmuz 2023 tarihleri arasında elektif karın ve pelvik cerrahi esnasında olan iyatrojenik damar yaralanması nedeniyle damar cerrahı tarafından müdahale edilen hastalar retrospektif olarak incelendi.
Bulgular: Çalışmada ürolojik cerrahi girişim uygulanan 21 (%29,2) olguda, jinekolojik cerrahi tedavi uygulanan 35 (%48,6) olguda ve batın cerrahisi uygulanan 16 (%22,2) olguda iyatrojenik damar yaralanması meydana geldi. 29 hastada izole arteriyel yaralanma, 37 hastada izole venöz yaralanma ve 6 hastada hem arter hem de ven yaralanması vardı. 24 hastaya embolektomi uygulandı. Hastaların 22'sine primer sütür, 13'üne ven grefti ile uç uca anastomoz, 11'ine dacron/PTFE ile uç uca anastomoz yapıldı. 10 hastaya nativ ven uç uca anastomozu yapıldı. 30 günlük takiplere bakıldığında 3 hastada arter tıkanıklığı, 2 hastada venöz tromboz olduğu görüldü. Hastanede ve 30 günlük takipte mortalite olmadı.
Sonuç: Elektif karın ve pelvik ameliyatlarda damar yaralanmaları nadiren de olsa görülür. Ancak gerçekleştiğinde mortal seyredebilir. Bu nedenle özellikle kitle eksizyonları ve damar yakınlığı olan lenf nodu diseksiyonlarında ameliyat öncesi multidisipliner değerlendirme vasküler komplikasyonları en aza indirecektir. (SETB-2024-03-048) Anahtar Kelimeler: Abdominal cerrahi, iatrojenik yaralanmalar, iatrojenik damar travması
Iatrogenic Vascular Injuries in Elective Abdominal and Pelvic Surgery Patients: Retrospective, Single Center, 30-Day ResultsMehmet Ali Yesiltas, Yasar Gokkurt, Serkan Ketenciler, Cihan Yucel, Melek Yilmaz, Ilhan Ozgol, Mehmet Kursat Kurt, Seran GulbudakDeparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
INTRODUCTION: Although rare, vascular injuries are common in elective abdominal or pelvic surgeries. When encountered, any problem in the relevant artery/vein (occlusion, stenosis, dissection, pseudoaneurysm or arteriovenous fistula) is associated with mortality and morbidity in both the short and long term. We aimed to share our treatment approach and short-term results for vascular injuries in elective surgery.
METHODS: In this study, the clinical data of patients who underwent elective abdominal and pelvic surgery performed by a vascular surgeon and who sustained iatrogenic vascular injury between January 2018 and July 2023 were retrospectively examined. All patients with no iatrogenic vascular injuries were excluded from the study.
RESULTS: In the present study, a total of 72 patients had iatrogenic vascular injuries and underwent vascular surgery. The average age of the patients was 50.8 ± 14.6 years. Twenty-eight (38.8%) of the patients were male, and 44 (61.1%) were female. Iatrogenic vascular injury occurred in 21 (29.2%) patients who underwent urologic surgical interventions, 35 (48.6%) who underwent gynecologic surgical treatments, and 16 (22.2%) who underwent abdominal surgeries. Twenty-nine patients had isolated arterial injuries, 37 patients had isolated venous injuries, and 6 patients had both arterial and vein injuries. Embolectomy was performed in 24 patients. Primary sutures were applied in 22 patients, end-to-end anastomosis with a vein graft was performed in 13 patients, and end-to-end anastomosis with Dacron/PTFE was performed in 11 patients. In 10 patients, native vein end-to-end anastomosis was performed. During the 30-day follow-up period, 3 patients experienced arterial occlusion, and 2 patients experienced venous thrombosis. There was no mortality in the hospital or during the 30-day follow-up period.
CONCLUSION: Vascular injuries rarely occur in elective abdominal and pelvic surgeries. However, when they happen, they are fatal. For this reason, preoperative, multidisciplinary evaluation will minimize the risk of vascular complications, especially in patients requiring mass excision and lymph node dissection with close vascular proximity. Keywords: Abdominal surgeries, iatrogenic injuries, iatrogenic vascular trauma
Sorumlu Yazar: Mehmet Ali Yesiltas
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