Iatrogenic arterial injuries of spine and orthopedic operations.
OBJECTIVE
To describe the results of contemporary management of iatrogenic arterial injuries following spine and orthopedic operations.


METHODS
Patients with major arterial injuries following spine and orthopedic operations in four teaching hospitals (Henry Ford Hospital, Detroit, Mich; Henry Ford Macomb Hospital, Clinton Township, Mich; St John Macomb Hospital, Warren, Mich; and St John Hospital, Detroit, Mich) over the last 10 years were studied. Data were collected on a continuous basis from vascular registries and analyzed retrospectively.


RESULTS
Seventeen patients (8 spine, 9 orthopedic operations) had iatrogenic arterial injuries manifest as thrombosis or laceration with bleeding, pseudoaneurysm, or arteriovenous fistula. The majority of arterial lacerations with bleeding and pseudoaneurysms were treated with open surgical repair while the majority of thromboses and arteriovenous fistulae were treated with endovascular techniques. Fasciotomy was necessary in three of seven patients with arterial complications of knee and hip operations. There was no mortality or limb loss. Significant morbidity in the form of foot drop (1), iliac vein thrombosis (2), delayed ambulation due to hematoma and swelling of the lower extremity (2), and ischemic myonecrosis of calf muscles (1) occurred. Two patients launched legal action.


CONCLUSIONS
Arterial injuries following orthopedic and spine operations can be successfully managed by both open and endovascular techniques. Significant morbidity and increased length of stay is common. Patient dissatisfaction with the complication and need for ensuing treatment can have significant medicolegal consequences.
Division of Vascular Surgery, Henry Ford Health Systems, Detroit, Mich, USA. sshans@att.net
Sachinder Singh
SS
Hans
Alexander D
AD
Shepard
Pritham
P
Reddy
Kumara
K
Rama
William
W
Romano
D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000628:therapy; D001158:Arteries / Q000293:injuries / Q000601:surgery; D001164:Arteriovenous Fistula / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects; D000071938:Fasciotomy; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006784:Hospitals, Teaching; D006801:Humans; D007049:Iatrogenic Disease; D007902:Length of Stay; D023821:Limb Salvage; D008297:Male; D008824:Michigan; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010359:Patient Readmission; D017060:Patient Satisfaction; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*; D013927:Thrombosis / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*