The Significant Burden of Iatrogenic Vascular Injury on the Vascular Surgery Workforce at an Academic Medical Center

Abstract

The treatment of iatrogenic vascular injury remains a critical role of the vascular surgeon, especially in the context of the increasing adoption of percutaneous procedures by other inpatient services. Vascular surgeons are called upon to provide emergent surgical assistance to other specialties for iatrogenic complications, both intraoperatively and at the bedside. This study aims to characterize consultation timing, management, and outcomes for iatrogenic vascular injuries. This study identified patients for whom vascular surgery was consulted for iatrogenic vascular complications from February 1, 2022, to January 8, 2023. Patient information, including demographic information, injury details, and details of any operative intervention, were retrospectively collected from February 1 to October 13 and prospectively collected for the remainder of the study period. Analyses were performed with R version 2022.02.03. There were 63 patients with consultations related to iatrogenic vascular injury. Of these, 29 (46%) were female and the mean age was 59 ± 18 years. The most common consulting services were cardiology (32%), cardiothoracic surgery (27%), and neurointerventional radiology (10%). Reasons for consultation included hemorrhage (38%), limb ischemia (32%), and treatment for pseudoaneurysm (27%). Of the consults, 25% were intraoperative, 19% related to ECMO cannulation, and 19% related to ventricular assist devices including left ventricular assist devices and intra-aortic balloon pumps. The majority of consult requests occurred during evening and night hours (5 pm to 7 am) (60%) (Figure). Emergent intervention was required in 75% of cases and consisted of: primary open surgical repair of arterial injury (50%), endovascular intervention (15%), and open thromboembolectomy (13%). Overall, in-hospital mortality for the patient cohort was 18% and the reintervention rate was 21%, reflecting the underlying complexity of the illness and nature of the vascular injury in this patient group. Vascular surgery plays an essential role in managing emergent life-threatening hemorrhagic and ischemic iatrogenic vascular complications in the hospitalized setting. These consults and complications require immediate bedside or intraoperative consultation and often emergent open surgical or endovascular intervention. Furthermore, many of these require urgent management in the evening or overnight hours, and therefore the high frequency of these events represents a potential significant resource utilization and workforce issue to vascular surgeons.