Iatrogenic vascular injuries in Sweden. A nationwide study 1987-2005.
OBJECTIVE
To study the epidemiology of vascular injuries, with special focus on iatrogenic vascular injuries (IVIs) and time-trends.


METHODS
From the Swedish national vascular registry, Swedvasc, prospectively registered data on vascular injuries during 1987-2005 were analysed and cross-referenced for mortality against the population registry.


RESULTS
Of 1853 injuries, 48% were caused by iatrogenic, 29% penetrating and 23% blunt trauma. In the three groups median age was 68, 35 and 40 years, respectively. The annual incidence of procedures for vascular injuries increased from 1.2-1.6 per 100 000 inhabitants and the proportion of IVIs increased from 41 to 51%, during the period. Mortality was higher after IVI (4.9%) compared to non-IVI (2.5%). Patients with IVI also had more co-morbidities; 58% cardiac disease, 44% hypertension, and 18% renal dysfunction. Among 888 IVIs, right femoral arterial injury was the most frequent (37%). The most common vascular reconstruction was direct suture (39%) followed by by-pass or interposition graft (19%, of which prosthetics were used in over half the cases). Endovascular repair increased from 4.6% to 15% between 1987 and 2005.


CONCLUSIONS
Vascular injuries, in particular iatrogenic ones, appear to be increasing. Iatrogenic injuries affect vulnerable patients with co-morbidities and are associated with a high mortality.
Rudström
H
H
Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University Hospital, Sweden. hakan.rudstrom@akademiska.se
Bergqvist
D
D
Ogren
M
M
Björck
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014656:Vascular Surgical Procedures; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D014950:Wounds, Penetrating / Q000209:etiology / Q000401:mortality* / Q000601:surgery