Inadvertent arterial injury secondary to treatment of venous insufficiency.
Arterial injury during treatment of varicose veins is a rare but devastating complication that can lead to leg amputation. Approximately 6,000 patients were treated by either surgery (4,800 patients treated by ligation, stripping, and stub avulsion) or ultrasound-guided foam sclerotherapy (USGS) (1,200 patients) in the last 7 years for venous insufficiency at three medical centers. Six patients (0.1%) sustained inadvertent arterial injury. The incidence of arterial injury during surgery was 0.06% (3 of 4,800) and was of a mechanical nature amenable to repair. None of these patients had tissue loss. The injury during USGS (0.25%, 3 of 1,200) was of a chemical and irreversible nature. All three patients suffered tissue loss. In our experience, the incidence of arterial injuries during USGS is four times higher than during traditional surgery and carries a much higher risk of tissue loss. Although experience, technical skill, and awareness of this complication help reduce the incidence of arterial injury during surgery, they seem to offer no protection during USGS. Careful mapping of the arterial venous communications and avoidance of high-risk zones will help prevent this complication.
Nitecki
Samy S
SS
Department of Vascular Surgery and Transplantation, Rambam Medical Center, Technion, Haifa 36091, Israel. s_nitecki@rambam.health.gov.il
Bass
Arie
A
D000293:Adolescent; D000328:Adult; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D005260:Female; D005263:Femoral Artery / Q000293:injuries / Q000601:surgery; D006801:Humans; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods; D014034:Toes / Q000098:blood supply; D016896:Treatment Outcome; D014648:Varicose Veins / Q000601:surgery*; D014689:Venous Insufficiency / Q000601:surgery*