Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 751 85 Uppsala, Sweden.
World J Surg. 2013 Aug;37(8):1981-7. doi: 10.1007/s00268-013-2061-2.
The aim was to study the nature of iatrogenic vascular injuries (IVIs) associated with postoperative death within 30 days.
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.
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.
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.
本研究旨在探讨与术后 30 天内死亡相关的医源性血管损伤（IVI）的性质。
1987 年至 2008 年期间，通过瑞典国家血管登记处前瞻性报告的 IVI 患者接受血管手术，并与国家人口登记处进行交叉核对。对术后 30 天内死亡的患者进行病历和死亡证明的研究。
共确定了 56 例术后 30 天内发生 IVI 死亡的患者。其中，有 52 例病历（93%）被检索到。24 例 IVI 是由血管内介入治疗中的穿刺引起的（13 例出血，11 例闭塞性血栓形成），11 例是由开放性手术中的穿透性创伤引起的，6 例是由外部压迫后的闭塞引起的，6 例是由经皮意外动脉穿刺引起的。主要症状是周围缺血（19/52，37%）、外出血（14 例，27%）和无外出血的低血容量性休克（10 例，19%）。主要涉及的专业是介入放射学（n=18）、普通外科（n=9）和介入心脏病学（n=8）。总体而言，22 例（42%）是可以避免的，只有 13 例（25%）进行了尸检。在 2 周内，36 例患者（69%）死亡。此外，IVI 与死亡之间的关联不确定的比例更高。
介入放射学、普通外科和心脏病学是导致 IVI 致死的主要专业。并非所有 IVI 后的死亡都归因于损伤本身，但几乎一半的损伤是可以避免的。
