medigraphic.com
Órgano Oficial de la Sociedad Mexicana de Angiología y Cirugía Vascular

2005, Number 2

<< Back Next >>

Rev Mex Angiol 2005; 33 (2)

Iatrogenic vascular injuries. A review of 140 patients

Sigler ML, Castañeda GR, Rish FL, Rodríguez-Trejo JM, Padilla-Sánchez L, Gutiérrez- Carreño R

Language: Spanish
References: 32
Page: 42-49
PDF size: 267.79 Kb.


ABSTRACT

Background: Iatrogenic vascular injuries are increasing and so severe that they can lead to prolonged hospitalization, high cost, loss of limb and even death of the patient with consequent lawsuit.
Objective: To review the incidence and pattern of iatrogenic vascular injuries, that have occurred during the last 32 years in several healthcare institutions of Mexico City.
Methods: It is a retrospective review of the records of 140 treated patients in five healthcare institutions from 1972 to 2004. There were 82 men and 58 women with age ranging from newborn to 82 years, with a mean age of 25 years. We recorded information on the original intervention, anatomic site of the injury, type of complication, outcome of the treatment and the incidence of lawsuits.
Results: There were 80 cases with arterial injury, 33 of venous ones and 27 injuries affecting both vessels. The injuries were located in the thorax of 11 patients, 30 in abdomen, 25 in upper limb, 69 in lower limb, and 19 had venous thromboembolic complications. The injuries happened as a surgical accident in 50 cases, during cardiac catheterization in 23, vein dissection in 15, arteriography in six and laparoscopy in five patients. There were 35 arterial thrombosis, seven arteriovenous fistulae, 5 pseudoaneurysms and 33 miscellaneous lesions. Microsurgical repair was successfully performed in five children with arterial thrombosis and post catheterization ischemia. Outcome: 99 patients (70%) recovered completely, 27 (19%) had amputations and 14 (10%) died. 18 patients (12%) brought lawsuits.
Conclusions: Every surgeon should keep in mind that an accident may occur at any time and aggravate the patient’s course. Hemorrhage, intimal tear, thromboembolism, pseudoaneurysms and arteriovenous fistulae were recorded in this review. Early recognition and correction of these injuries reduce the incidence and severity of the complications. Vascular access, minimally invasive surgery, orthopedic and general procedures were the main cause of severe iatrogenic lesions. The use of endovascular diagnostic and therapeutic procedures has motivated an increase in the number of iatrogenic injuries. Simple procedures such as sclerotherapy and vein stripping were not excluded. Particular attention must be paid to pediatric patients. Medical records must be complete if regarding any abnormal outcome; review by special committees must be done and iatrogenia analyzed to keep the staff informed and prevent the occurrence of similar injuries.


REFERENCES

  1. Starfield B. Is US health really the best of the world? JAMA 2000; 284: 483-5.

  2. Nehler MR, Taylor LM Jr., Porter JM. Iatrogenic vascular trauma. Semin Vasc Surg 1998; 11: 283-93.

  3. Giswold ME, Landry GJ, Taylor LM, Moneta GL. Iatrogenic arterial injury is increasingly important cause of arterial trauma. Am J Surg 2004, 187: 590-2.

  4. Bergentz SE, Bergqvist D. Iatrogenic Vascular Injuries. Berlin: Springer-Verlag; 1989.

  5. Villavicencio JL, González Cerna JL, Velasco P. Acute vascular problems of children. Current problems in surgery; 1985, p. 6-10.

  6. Cervantes J. Iatrogenia en cirugía. México: Salvat Editores; 1991.

  7. Sigler Morales L, Castañeda Gaxiola R, Rish Fein L. (Eds.). Lesiones vasculares por iatrogenia. México: El Manual Moderno; 2004.

  8. Lizola MR, Sánchez FC, Sigler ML, Carvajal CG, Victoria GR, González DLC. Fístulas aortocavatraumáticas. Rev Mex Angiol 1992; 20: 43-7.

  9. Rodríguez Trejo JM, Oropeza Martínez G, Hurtado del Río D, Borja Martínez A, Gómez Álvarez E, Pulido Flota MC, Cárdenas Álvarez S. Fístula arteriovenosa después de laminectomía lumbar. Rev Mex Angiol 1995; 23: 60-5.

  10. Rosales Jiménez JM, Sánchez Fabela C, Velasco Ortega CE. Trauma vascular. Experiencia de cinco años. Rev Mex Angiol 1995; 23: 21-5.

  11. Rojas GA, Cervantes J, Kleinfinger S, Dabbah J, Klériga E, Guzmán de Alba E. Lesión vascular durante laminectomía lumbar. Rev Mex Angiol 1996; 24: 50-4.

  12. Ramírez-González AH. Trauma vascular. Experiencia en la práctica privada (1982-1993). Rev Mex Angiol 1996; 24: 6-9.

  13. Reyes Aguirre OE, Meza Izquierdo H, Sánchez Fabela C. Trauma vascular. Rev Mex Angiol 1998; 26: 92-6.

  14. Ramírez Espinosa F. La iatrogenia vascular. Rev Mex Angiol 1998; 26: 46-8.

  15. Rojas GA, Cervantes J. Lesiones vasculares iatrogénicas. Rev Mex Angiol 1999; 27: 89-94.

  16. Rodríguez Trejo JM, Rodríguez RN, Villa GMG, Camarillo GF. Complicaciones asociadas al uso de balón intraaórtico de contrapulsación. Rev. Mex Angiol 1999; 27: 78-88.

  17. Rodríguez Trejo JM, Mendoza Cortés A, Flores Padilla CM, Montuy Vidal MA, Sulvarán Aguilar A, Escoto Sánchez I. Iatrogenia vascular en pacientes pediátricos. Rev Mex Angiol 2000; 28: 96-102.

  18. Aguilar Rebolledo F, Rodríguez Zepeda MC. Trombosis en niños. En: Sigler L, Castañeda R, Athié J (Ed.). Trombosis venosa profunda y embolia pulmonar. México, D.F.: McGraw Hill Interamericana; 2002, p. 365-6.

  19. Gutiérrez Carreño R, Sánchez Fabela C, Piña Marshall S, Bosh J. Trombosis aórtica neonatal. Bol Med Hosp Infant 1980; 37: 425-8.

  20. Rojas GA, Cervantes J, Cicero Lebrija A. Lesiones vasculares iatrogénicas en cirugía de columna. En: Sigler Morales L y cols.; 2004; p. 145-52.

  21. Cervantes Castro J, Rojas Reyna G, Álvarez O. Lesiones vasculares iatrogénicas en cirugía ortopédica. En: Sigler Morales L y cols.; 2004; p. 133-44.

  22. Arias Gómez E, Castañeda Gaxiola R, Sigler Morales L, Rish Fein L. Lesiones vasculares iatrogénicas en cirugía general. En: Sigler Morales L y cols.; 2004; p. 153-80.

  23. Volkow P, Téllez O, Barrera L, Izaguirre R, Baltazares E, Cortina E. Trombosis venosa vinculada al uso de catéteres intravenosos. En: Sigler Morales L y cols.; 2004; p. 349-61

  24. Juárez Becerra J, Rodríguez Trejo JM, Rodríguez Ramírez N, Enríquez Chena EA. Complicaciones vasculares en cateterismos cardiacos. Rev Mex Angiol 1998; 26: 6-12.

  25. Careaga G, Esparza J, Arguero R. Complicaciones vasculares en el implante de marcapaso endocárdico definitivo. Rev Mex Angiol 1998; 26: 38-40.

  26. López Silva J, Gutiérrez Vogel S, Hernández Salgado R. Fístulas arteriovenosas internas en nuestro medio. Rev Mex Angiol 1985; 13: 37-42

  27. Cote Estrada L, García Torres PO (Ed.) La Práctica Médica y sus Controversias Jurídicas. México, D.F.: Editora Científica Médica Latinoamericana; 2002.

  28. Landrigan CP, Rothschild JM, Cronin JW, Causal R y cols. Effect of reducing interns’ work hours in serious medical errors in intensive care units. N J Med 2004; 351: 1838-48.

  29. Adar R, Bass A, Walden R. Iatrogenic complications in surgery. Five-year experience in general and vascular surgery in a university hospital. Ann Surg 1982; 196: 725-9.

  30. Somellera Caraveo R. Síndrome compartimental y contractura isquémica de las extremidades. En: Sigler Morales L y cols.; 2004, p. 289-304

  31. Mills JL, Wiedeman JE, Robinson JG, Hallet JW Jr. Minimizing mortality and morbidity from iatrogenic arterial injuries: the need for early recognition and prompt care. J Vasc Surg 1986; 4: 22-6.

  32. Bergan JJ. Litigation in vascular trauma. In: Flanigan DP (Ed.). Civilian vascular trauma. Philadelphia: Lea & Febiger; 1992, p. 465-70.




2020     |     www.medigraphic.com