title: Iatrogenic vascular injuries with lethal outcome.
abstract: BACKGROUND
  The aim was to study the nature of iatrogenic vascular injuries (IVIs) associated with postoperative death within 30 days.
  
  
  METHODS
  Patients who had undergone vascular surgery for IVIs and were reported prospectively to the Swedish national vascular registry during 1987-2008 were identified. They were cross-checked with the national population registry. Those who died within 30 days of surgery were studied regarding case records and death certificates.
  
  
  RESULTS
  A total of 56 patients with postoperative death within 30 days after IVI were identified. Among them, 52 case records were retrieved (93 %). In 24 cases the IVIs were caused by puncture during endovascular procedures (13 hemorrhage, 11 occlusive thrombosis), 11 by penetrating trauma during open surgery, 6 by occlusion after external compression, 6 by percutaneous accidental arterial puncture. Main symptoms were peripheral ischemia (19/52, 37 %), external bleeding (14, 27 %), and hypovolemic shock without external bleeding (10, 19 %). Main specialties involved were interventional radiology (n = 18), general surgery (n = 9), and interventional cardiology (n = 8). Overall, 22 (42 %) were avoidable, and only 13 (25 %) underwent autopsy. Within 2 weeks, 36 patients (69 %) were dead. Also, there was a higher proportion with uncertain correlation between IVI and death.
  
  
  CONCLUSIONS
  Interventional radiology, general surgery, and cardiology are the main specialities involved in IVIs with lethal outcome. Not all fatalities after IVI are attributable to the injury itself, but almost half of the injuries were considered avoidable.
authors: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 751 85 Uppsala, Sweden. rudstrom.hakan@telia.com
authors: H
authors: H
authors: Rudström
authors: D
authors: D
authors: Bergqvist
authors: M
authors: M
authors: Björck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000401:mortality* / Q000601:surgery
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