title: Iatrogenic vascular injuries in varicose vein surgery: a systematic review.
abstract: BACKGROUND
  Iatrogenic vascular injuries during varicose vein surgery are serious. The aim of this study was to investigate their nature and consequences.
  
  
  METHODS
  A systematic literature research was performed.
  
  
  RESULTS
  The incidence is low (0.0017%-0.3%). We found 81 patients suffering from 87 vascular injuries-44 arterial and 43 deep vein injuries.
  
  
  CONCLUSIONS
  Vascular injuries during varicose surgery are rare but serious. They are avoidable, and when they occur, early recognition is crucial. Bleeding is a common symptom, especially in deep venous injury. In our study, we reviewed the literature on 81 patients with 87 vascular injuries. Laceration or division of the femoral vein dominated venous injuries (28/43). Partial stripping of the femoral vein was not common (4/43) and occurred when the strip probe passed into the deep veins through a perforator. Arterial stripping predominated in arterial injuries (17/44) and happened when stripping distally during a primary operation, as reported by experienced surgeons, in nonobese women. Major arterial complications resulted in ischemia, often with diagnostic delay and poor reconstruction results. Only 30% (13/44) of arterial injuries were detected peroperatively. The amputation rate was 34% (15/44), but rose to 100% if combined with intra-arterial sclerotherapy (5/5 cases). When stripping an artery below the femoral artery, the amputation rate was high (42%; 5/12) and morbidity severe (85%; 11/12). All fatal injuries (5 cases) were venous. Anatomic knowledge and awareness of the possibility of vascular complications should be preventive. Early detection by routine checking of arterial circulation is important.
authors.affiliation: Department of Surgery, Uppsala University Hospital, Uppsala, Sweden. hakan.rudstrom@akademiska.se
authors.forename: Håkan
authors.initials: H
authors.lastname: Rudström
authors.forename: Martin
authors.initials: M
authors.lastname: Björck
authors.forename: David
authors.initials: D
authors.lastname: Bergqvist
mesh_terms: D005263:Femoral Artery / Q000293:injuries*; D005268:Femoral Vein / Q000293:injuries*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D022125:Lacerations / Q000453:epidemiology*; D014648:Varicose Veins / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*