10 : 461-467, 2001 24 1 1 1 2 1991 10 24 retrospective 11 13 10 85 53.7 13 11 3 3 IVH 2 2 PCPS 2 IABP 1 4 3 1 8 9 AVF 5 1 1 5 1 1 1 1 6 3 2 1 1 3 2 PCPS AVF 1 4 10 : 461-467, 2001 IVR 1 Tel: 0423-23-5111 183-8524 2-9-2 2 2000 12 5 2001 3 23 1,2 interventional radiology IVR 3 1991 10 retrospective 1991 10 2000 10 9
10 4 Table 1 Diseases of the patients with iatrogenic vascular injuries Fig. 1 A 67-year-old man was admitted to our hospital because of acute myocardial infarction. Cardiac catheterization with PTCA was performed and he got well. But, AVF occurred in his right thigh. The angiogram shows the AVF between superficial femoral artery and femoral vein. 24 11 13 10 85 53.7 Table 1 7 24 1 13 3 PCPS 2 11 4 3 Table 2 9 5 4 7 1 8 2 6 IVC 2 3 1 AVF 5 1 Table 3Table 4 5 AVF Fig. 1 3 IABP 1 PCPS 2 IVH 1 1 8 Fig. 2 Table 2 Type of procedures of iatrogenic vascular injuries 10
2001 6 Table 3-1 Clinical features, injured vessels and treatments of the patients (Injured with catheterization) Table 3-2 Clinical features, injured vessels and treatments of the patients (Injured with surgical procedure) Fig. 2 A 48-year-old woman had right heminephrectomy for reccurent pyeronephritis and her IVC was lacerated. CT performed before operation shows inflammation arround her right kidney and IVC. (Arrow heads show inflammation and arrow shows IVC) Fig. 3 A 49-year-old man was suffered from expanding hematoma in his neck because of a traffic accident. He had a surgical operation to ligate injured vessels but failed and was sent to our hospital. Embolization was performed and resulted in success. (Arrow shows a metalic coil for hemostat) 11
Table 4 Main causes of vascular injuries 3 2 20 18 2 IVR 4 3 2 1 1 AVF 8 5 1 1 TAE 1 Fig. 3 3 Fogarty 2 1 5 1 4 IVC 1 CPA 2 1 AVF 1 1 3 1 1 neuralgia 1 Table 3 1 1 10 4 1,4 Bergentz 1 5 IABP pump failure 3 1 PCPS 1979 CPA 6 1999 2 CPA 12 2 10 26 CPA PCPS 2 IVH IVH 1 IVH 5 AVF 3 2 1 3 8F 24 AVF 7,8 12
2001 6 8F 9 24 AVF IVH 8 3 cytoreduction surgery 1 5 reduction surgery 4 7 1 6 1 8 6 TAE TAE TAE 1 10 11 Lazarides 2 2 1 non-reflow phenomenon 5P Bliss 12 editorial AVF 13 AVF 1,5 3 1 1 4 5 1 2 13
4,14 Lazarides 2 15.5% IVC 15 1 QOL QOL 1 2 24 IABP PCPS AVF IVR 1 Bergentz, S. E. and Bergqvist, D.: Iatrogenic Vascular Injuries. Berlin, 1989, Springer-Verlag. 2 Lazarides, M. K., Tsoupanos, S. S., Georgopoulos, S. 10 4 E. et al.: Incidence and patterns. Surgery, 39: 281-285, 1998. 3,, : 15., 4: 389-393, 1995. 4,, :., 9: 403-407, 2000. 5 :., 17: 821-824, 1993. 6,, : 1., 29: 122-125, 2000. 7 Rutherford, R. B.: Vascular Surgery, 4th. Philadelphia, 1995, Saunders. 8 Orcutt, M. B., Levine, B. A., Gaskill, H. V. et al.: Iatrogenic vascular injury A reducible problem. Arch. Surg., 120: 384-385, 1985. 9 Roberts, S. R., Main, D. and Pinkerton, J. P.: Surgical therapy of femoral artery pseudaneurysm after angiography. Am. J. Surg., 154: 676-680, 1987. 10 : IVR,., 1998,. 11 Bergqvist, D. and Bergqvist, A.: Vascular injuries during gynecologic surgery. Acta Obstet. Gynecol. Scand., 66: 19-23, 1987. 12 Bliss, B., Mansfield, A. O., Shepherd, R. et al.: Vascular injuries. J. Bone Joint Surg.,71-B: 738, 1989. 13 Malone, A., Ingledew, N., Cheshire, N. et al.: Endovascular repair of an iatrogenic left common carotid to innominate vein fistula. Eur. J. Endovasc. Surg., 18: 532-533, 1999. 14 AlZahrani, H. A. and Saleh, T. R.: Iatrogenic vascular injuries in Western Saudi Arabia. Cardiovasc. Surg., 3: 39-41, 1995. 15 Millis, J. L., Wiedeman, J. E., Robinson, J. G. et al.: Minimaizing mortality and morbidity from iatrogenic arterial injuries: The need for early recognition and prompt repair. J. Vasc. Surg., 4: 22-27, 1986. 14
2001 6 Iatrogenic Vascular Injury An Analysis of 24 Cases Akira Oshima 1, Mikio Yuri 1, Tomohito Minami 1 and Yukari Takada 2 1 Department of Surgery and 2 Department of Radiology, Tokyo Metropolitan Fuchu Hospital Key words: Iatrogenic vascular injury, Diagnostic catheterization (complications of), Therapeutic catheterization (complications of), Surgical procedure (complications of), Interventional radiology We retrospectively analysed 24 cases of iatrogenic vascular injuriy (IVI) seen at our institute from Octorber 1991 through Octorber 2000. Diagnostic or therapeutic catheterization accounted for 13 cases, whereas, the remainder (11 cases) occurred during surgical procedures: 3 cases occurred after cardiac catheterization, 3 resulted from catheterization for hemodialysis. Central venous catheterization, femoral angiography and percutaneous cardiopulmonary supporting system (PCPS) were the cause in two cases each, while IABP caused IVI in one. On the other hand, 4 radical resections of cancer were the source of IVI, while resection of reccurent cancer caused 3. Insertion of an inflation needle at laparoscopy, right heminephrectomy, removement of expanding hematoma and fixation of the femur were the cause of IVI in one each. The symptom was bleeding in 8, and 5 were treated with lateral suture. Vein patch, ligation and embolization were performed in one each. One patient with cirrhosis died of hepatic failure. There were 9 acute arterial occlusions in 9 patients, 6 of which were treated and 3 were not. Thrombectomy was performed in 3 patients, two bypass operations in two and one was recanalized with thrombolytic therapy. One patient had a major amputation because her severe leg ischemia was overlooked for a long time. Five arterio-venous fistulae occurred in 5 patients: 4 were treated with resection and one closed spontaneously. One laceration was repaired with end to end anastomosis and one pseudoaneurysm was treated with a vein patch. Puncture for catheterization must be done at a proper vascular site and surgical strategy for advanced or reccurent cancer must be properly determined. (Jpn. J. Vasc. Surg., 10 : 461-467, 2001) 15