Ali Yesiltas Mehmet, Gokkurt Yasar, Ketenciler Serkan, Yucel Cihan, Yilmaz Melek, Ozgol Ilhan, Kursat Kurt Mehmet, Gulbudak Seran
Deparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye.
Sisli Etfal Hastan Tip Bul. 2024 Sep 30;58(3):319-324. doi: 10.14744/SEMB.2024.19971. eCollection 2024.
Although rare, vascular injuries are common in elective abdominal or pelvic surgeries. When encountered, any problem in the relevant artery/vein (occlusion, stenosis, dissection, pseudoaneurysm or arteriovenous fistula) is associated with mortality and morbidity in both the short and long term. We aimed to share our treatment approach and short-term results for vascular injuries in elective surgery.
In this study, the clinical data of patients who underwent elective abdominal and pelvic surgery performed by a vascular surgeon and who sustained iatrogenic vascular injury between January 2018 and July 2023 were retrospectively examined. All patients with no iatrogenic vascular injuries were excluded from the study.
In the present study, a total of 72 patients had iatrogenic vascular injuries and underwent vascular surgery. The average age of the patients was 50.8±14.6 years. Twenty-eight (38.8%) of the patients were male, and 44 (61.1%) were female. Iatrogenic vascular injury occurred in 21 (29.2%) patients who underwent urologic surgical interventions, 35 (48.6%) who underwent gynecologic surgical treatments, and 16 (22.2%) who underwent abdominal surgeries. Twenty-nine patients had isolated arterial injuries, 37 patients had isolated venous injuries, and 6 patients had both arterial and vein injuries. Embolectomy was performed on 24 patients. Primary sutures were applied in 22 patients, end-to-end anastomosis with a vein graft was performed in 13 patients, and end-to-end anastomosis with Dacron/PTFE was performed in 11 patients. In 10 patients, native vein end-to-end anastomosis was performed. During the 30-day follow-up period, 3 patients experienced arterial occlusion, and 2 patients experienced venous thrombosis. There was no mortality in the hospital or during the 30-day follow-up period.
Vascular injuries rarely occur in elective abdominal and pelvic surgeries. However, when they happen, they are fatal. For this reason, preoperative, multidisciplinary evaluation will minimize the risk of vascular complications, especially in patients requiring mass excision and lymph node dissection with close vascular proximity.
血管损伤虽罕见，但在择期腹部或盆腔手术中较为常见。一旦发生，相关动脉/静脉的任何问题（闭塞、狭窄、夹层、假性动脉瘤或动静脉瘘）均与短期和长期的死亡率及发病率相关。我们旨在分享我们对择期手术中血管损伤的治疗方法及短期结果。
在本研究中，回顾性分析了2018年1月至2023年7月期间由血管外科医生进行择期腹部和盆腔手术且发生医源性血管损伤的患者的临床资料。所有无医源性血管损伤的患者均被排除在研究之外。
在本研究中，共有72例患者发生医源性血管损伤并接受了血管手术。患者的平均年龄为50.8±14.6岁。28例（38.8%）患者为男性，44例（61.1%）为女性。医源性血管损伤发生在21例（29.2%）接受泌尿外科手术干预的患者、35例（48.6%）接受妇科手术治疗的患者以及16例（22.2%）接受腹部手术的患者中。29例患者为单纯动脉损伤，37例患者为单纯静脉损伤，6例患者同时有动脉和静脉损伤。24例患者进行了栓子切除术。22例患者采用了一期缝合，13例患者采用静脉移植物进行端端吻合，11例患者采用涤纶/聚四氟乙烯进行端端吻合。10例患者进行了自体静脉端端吻合。在30天的随访期内，3例患者发生动脉闭塞，2例患者发生静脉血栓形成。住院期间及30天随访期内均无死亡病例。
血管损伤在择期腹部和盆腔手术中很少发生。然而，一旦发生，后果严重。因此，术前多学科评估将最大限度地降低血管并发症的风险，尤其是在需要广泛切除和靠近血管进行淋巴结清扫的患者中。
