Iatrogenic arterial injury is an increasingly important cause of arterial trauma

Abstract

Background Iatrogenic arterial injuries (IAI) may result from any invasive diagnostic or therapeutic procedure. The relative occurrence and severity of IAI compared with those of penetrating and blunt vascular trauma is unknown. A review of arterial trauma at a university hospital level 1 trauma center, with a focus on iatrogenic injury, forms the basis of this report. Methods Patients treated for arterial trauma from January 1994 through October 2002 were identified from prospectively maintained registries. Record review included injury etiology, type of repair, 30-day all-cause mortality, and permanent morbidity. Permanent morbidity was defined as amputation or loss of extremity function. Results In all, 252 patients required treatment, 85 (33.7%) from IAI, 86 (34.1 %) from penetrating trauma, and 81 (32.1%) from blunt trauma. During the study period, the number of IAIs per year increased. Femoral artery injury from percutaneous intervention (50, 58.8%) was the most frequent IAI; intraoperative injury (including 14 tumor resections and 5 orthopedic procedures) was next most frequent (23, 27.1%). Three patients (3.5%) with IAI had permanent morbidity. The 30-day all-cause mortality was 7.1% (6) for patients with IAI. Conclusions Iatrogenic arterial injury is increasingly frequent and caused one third of the arterial trauma at our level 1 trauma center. These data suggest education and training regarding IAI deserves equal priority with the study of penetrating vascular trauma.