Iatrogenic and noniatrogenic arterial trauma – a comparative study

Iatrogenic arterial trauma may arise in diagnostic or therapeutic  procedures   (Gr.   ἰατρός  =  physician, γεννώ = give birth to). The incidence of reported iatrogenic  arterial  trauma  has  clearly risen in recent years, as a result of the dramatically increased performance  of  cardiac  catheterization  and angiography, or of the increasingly  radical  operations now performed for a variety of lesions in all surgical fields.

This study compared patients with iatrogenic and noniatrogenic arterial injuries.

Although iatrogenic arterial trauma is a well defined clinical entity, its reported incidence in relation to total numbers of arterial injuries varies from 1.4% to 76% . In our study, 34% of the arterial injuries were iatrogenic. As some cases of iatrogenic arterial injury are not reported for fear of legal consequences, no clear picture of the problem’s size is obtainable.

The arteries of the extremities most often affected were brachial and femoral, the commonest sites of arterial puncture in the iatrogenic group, and leg arteries were mostly injured in noniatrogenic group. Orthopaedic and general surgery were responsible for most iatrogenic injuries. Haemorrhage, presenting either as an arterial bleed or as an expanding haematoma, occurred in 28 of our 43 non iatrogenic arterial injuries, but in only four of the 22 in the iatrogenic group (p < 0.001). The patients in that group presented mainly with severe or mild ischaemia.

The postoperative mortality rate did not differ significantly between iatrogenic and noniatrogenic group, which accords with previously reported corresponding rates of 10% and 15 % . Other authors found 4 %  or 1.7%  mortality in their series of iatrogenic vascular injury, compared with 14 % in our series.

Factors of two types have been implicated in iatrogenic vascular injury, viz. doctor-related (inadequate knowledge, inefficient anatomic dissection or traumatic or faulty technique) and patient-related (inflammation, tumour, irradiation, reoperation, anatomic variations). Most of them are related to arterial catheterization performed mainly by nonsurgeons.

As iatrogenic arterial injuries may occur even in the most capable hands, they must be recognized and adequately corrected so as to reduce the risk of incapacitating sequelae.

Το πλήρες άρθρο έχει δημοσιευτεί στο: [ Eur J Surg 1991; 157:17-20 ]

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