Major vascular injury during nonvascular surgeries.
BACKGROUND
Intraoperative vessel injuries can be serious enough to threaten the patient's survival. This study was performed to analyze the pattern, management, and outcome of intraoperative major vessel injuries and to clarify the risk factors leading to the injury.


METHODS
From January 2007 to July 2010, patients with intraoperative vessel injuries during nonvascular surgeries that were treated by vascular surgeons at a tertiary referral center were enrolled, and electronic medical records were reviewed retrospectively.


RESULTS
Twenty-seven intraoperative vessel injuries occurred during urologic (29.6%), general (29.6%), orthopedic (22.2%), gynecologic (14.8%), or neurosurgical (3.7%) operations. There were 17 cancer surgeries (63.1%), 3 benign tumor surgeries (11.1%), 2 nephrectomies, 2 spine surgery, and 1 knee arthroplasty. A vascular surgeon was contacted intraoperatively in 23 cases and postoperatively in 4. The presenting symptoms in the intraoperative contact group were bleeding (n = 21), bowel ischemia (n = 1), and decreased intraoperative sensory evoked potential (n = 1). In comparison, the presenting symptoms in the postoperative delayed contact group were leg ischemia in three cases and hematochezia in one case. All cases were arterial injuries in this group. There was one mortality (25%) due to ischemia-reperfusion syndrome and two significant morbidities (50%) that needed secondary operations including amputation and stent-graft insertion.


CONCLUSIONS
Intraoperative vessel injury was most common in cancer surgery. The mortality and morbidity rate was higher in the postoperative late contact group. Early diagnosis and prompt contact to a vascular surgeon could reduce serious complications.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Tae-Kyung
TK
Yoo
Seung-Kee
SK
Min
Sanghyun
S
Ahn
Seong-Yup
SY
Kim
Sang-Il
SI
Min
Yang Jin
YJ
Park
Jongwon
J
Ha
Sang Joon
SJ
Kim
D000671:Amputation, Surgical; D001158:Arteries / Q000293:injuries / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D012017:Referral and Consultation; D012086:Reoperation; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery