Iatrogenic Vascular Injuries During Abdominal Operations - Factors Associated With Injury-Related Death

Purpose: Operative vascular injuries are frequently challenging because of uncontrollable bleeding and difficult exposure. The purpose of this study was to review the management and clinical outcome of patients with serious operative injuries of abdominal and pelvic vessels.
Methods: We reviewed the clinical data of 103 patients with 124 iatrogenic vascular injuries sustained during non-vascular operations from 1985 to 2005. Variables were correlated with risk of injury-related death.
Results: There were 45 male and 58 female patients with a mean age of 52 years (range, 2-91 years). Predisposing factors for injury were oncologic resection (71%), hostile anatomy (57%), recurrent tumor (62%), prior operation (50%), and radiation therapy (27%). Venous injuries (n=45) involved the iliac veins (n=31), inferior vena cava (n=9), portal (n=8), and renal vein (n=2). Arterial injuries (n=68) involved iliac arteries (n=49), aorta (n=10), visceral (n=10), and renal arteries (n=5). Repair included arteriorrhaphy or venorrhaphy (46%), end-to-end anastomosis (21%), bypass grafting (19%), ligation (9%) or patch angioplasty/ venoplasty (5%). There were 10 injury-related deaths; causes of death were multisysem organ failure (n=4), disseminated intravascular coagulation (n=4), and uncontrollable hemorrhage or pulmonary embolism (n=1 each). Eighteen patients (17%) had major complications. Variables associated with increased risk (p<.05) of injury-related death were venous location, excessive blood loss, greater transfusion requirement and presence of severe acidosis (pH < 7.15).
Conclusion: Operative injuries of abdominal and pelvic veins are associated with significant morbidity and mortality specially in patients with venous injuries, massive bleeding, multiple transfusions and severe acidosis.