Iatrogenic Vascular Injuries in Resource-Limited Setting: A 4-Year Experience Monocentric Retrospective Study

Abstract

Nabeel Yahya Almadwahi,1 Ali Mohahmmed Alkadri,2 Ali Fadhel,3 Mohamed Alshujaa,1 Faisal Ahmed,4 Mohamed Badheeb5 1Department of Vascular Surgery, School of Medicine, Sana’a University, Sana’a, Yemen; 2Department of Vascular Surgery, School of Medicine, Ibb University, Ibb, Yemen; 3Department of Cardio-Pediatric Surgery, School of Medicine, Sana’a University, Sana’a, Yemen; 4Department of Urology, School of Medicine, Ibb University, Ibb, Yemen; 5Department of Internal Medicine, Yale New-Haven Health/Bridgeport Hospital, Bridgeport, CT, USACorrespondence: Ali Mohahmmed Alkadri, Department of Vascular Surgery, School of Medicine, Ibb University, Ibb, Yemen, Tel [phone], Email [email protected] Faisal Ahmed, Department of Urology, School of Medicine, Ibb University, Ibb, Yemen, Tel/Fax [phone], Email [email protected]: Iatrogenic vascular injuries (IVIs) due to diagnostic and therapeutic interventions are known but rare or probably under-reported. We present our four-year findings on patients with IVIs after catheterization or surgery who underwent vascular surgical repairs in a resource-limited setting.Methods: A retrospective case series study between Jun 2018 and Sep 2022 of 35 patients diagnosed with IVIs and treated surgically at our hospital was included. The data on IVIs including patient characteristics, causes and type of injury, treatment, and outcomes were collected and analyzed.Results: The mean age was 37.12± 17.0 years, and most patients (65.7%) were male. Of the 35 IVIs, 21 were caused by percutaneous procedures, while 14 occurred intraoperatively and affected various arteries and veins. The main injured vessels were the femoral artery (20%) and direct blood vessel puncture made by non-qualified specialists (42.9%) during dialysis cannulation was the main cause. The intraoperative IVI affected the inferior vena cava in three patients, the aorta in two patients, the external iliac artery in four, the tibial and popliteal arteries in four, and the internal carotid artery in one. The following types of repairs were recorded: direct suture of the vessel with or without endarterectomy (71.4%), synthetic patch placement (25.7%), ligation (8.6%), bypass or interposition graft (14.3%), and thromboembolectomy (5.7%). Vascular repair was successful in 32 (91.4%) patients while three patients (8.6%) were expired. Complications occurred in 7 (20%) patients, of which superficial wound infections were the common complication (11.6%) and were treated with proper antibiotic therapy.Conclusion: Prompt identification of IVIs, as well as proper triage for future treatment, can enhance patient outcomes. Our data showed that non-qualified specialists seem to be responsible for the majority of IVIs. For that, we emphasize the importance of performing vascular procedures by a qualified specialist with adequate training.Keywords: iatrogenic, vascular injury, adverse event, vascular surgical procedure

Keywords

• iatrogenic
• vascular injury
• adverse event
• vascular surgical procedure.