Iatrogenic operative injuries of abdominal and pelvic veins: a potentially lethal complication

Repair of the inferior vena cava with autogenous peritoneo-fascial patch graft following abdominal trauma: a case report

Abdominal vascular injuries are among the most challenging and lethal injuries in traumatized patients. Inferior vena cava is the most frequently injured vein during the blunt or penetrating trauma. The primary repair, end to end anastomosis, endovascular stenting, or graft interposition with autogenous or synthetic materials should be considered in selected cases. However, in cases the synthetic graft was preferred, intestinal contaminations due to small or large bowel perforation accompanying the trauma have been cited as a limiting factor for the use of such grafts as in the current case. However, a previous history of lower leg variceal surgery prevents the use of great saphenous vein as a graft. So in the present case, the authors report a patient with inferior vena cava injury repaired with autogenous peritoneo-fascial graft. The authors have used APF graft in traumatic inferior vena cava injury for the first time.

Implante de filtro em veia cava inferior dupla: relato de caso e revisão da literatura

Veia cava inferior dupla é uma variação anatômica rara cuja prevalência é de 0,2-3%. O implante de filtro de veia cava, quando indicado em casos com duplicidade da veia cava inferior, pode ser realizado de diferentes formas: em ambas as veias cavas; em uma delas, embolizando a anastomose entre ambas; em somente uma delas; ou por implante supra-renal. Relatamos um caso de trombose venosa profunda no pós-operatório de implante de prótese de quadril com contra-indicação para tratamento anticoagulante e cuja cavografia evidenciou duplicidade de veia cava inferior. O implante de filtro de veia cava inferior realizado em posição supra-renal mostrou-se opção adequada e segura.

Pulsatile flow phantom for ultrasound image-guided HIFU treatment of vascular injuries

A pulsatile flow phantom was developed for studies of ultrasound image-guided high intensity focused ultrasound (HIFU) application in transcutaneous hemostasis of injured blood vessels. The flow phantom consisted of a pulsatile pump system with instrumented excised porcine carotid artery, which was imbedded in a transparent agarose gel to model structural configuration of in vivo tissues. Heparinized porcine blood was circulated through the phantom. The artery was injured using an 18-gauge needle to model a penetrating injury in human peripheral vasculature. A HIFU transducer with the diameter of 7 cm, focal length of 6.3 cm and frequency of 3.4 MHz was used to seal the puncture. Ultrasound imaging was used to localize and target the puncture site and to monitor the HIFU treatment. Triphasic blood flows present in the human arteries were reproduced, with flow rates of 50 to 500 mL/min, pulse rates of 62 to 138 beats/min and peak pressures of 100 to 250 mm Hg. The penetrating injury of an artery was mimicked successfully in the flow phantom setting and was easily visualized both optically through the transparent gel and with power Doppler ultrasound imaging. Hemostasis was achieved in 55 +/- 31 s (n = 9) of HIFU application. Histologic observations showed that a HIFU-sealed puncture was filled with clotted blood and covered with a fibrin cap. The pulsatile flow phantom provides a controlled and repeatable environment for studies of transcutaneous image-guided HIFU application in hemostasis of a variety of blood vessel injuries.

Iatrogenic major venous injuries incurred during cancer surgery

PURPOSE

Iatrogenic operative injury to the major veins is associated with significant morbidity and mortality. This study was conducted to review the pattern, management, and outcome of iatrogenic major venous injuries incurred during cancer surgery.

METHODS

We reviewed 24 patients with collective 30 venous injuries, evaluating clinical characteristics; operative and postoperative data, including location and type of venous injury, operative repair, blood loss, and transfusion requirements; and outcome.

RESULTS

Thirty venous and 12 associated arterial injuries were identified. The two most common sites of venous trauma were the iliac and femoral veins with 10 (33.3%) and 9 (30.0%) injuries, respectively. Twenty-three (76.7%) of the venous injuries were repaired primarily or with end-to-end anastomosis, while the remaining injuries required interposition grafts, patch venoplasty, or venous ligation. Postoperative revision procedures were performed in 3 (12.5%) patients. Perioperative mortality was 16.7% and major complications developed in 11 (45.8%) patients.

CONCLUSIONS

Serious complications can be minimized by immediate recognition and prompt repair of iatrogenic vascular injuries. Close collaboration with a vascular surgeon during resection of tumors in proximity to the vascular structures may be helpful in preventing iatrogenic vascular injuries. In hospitals where tumor resection procedures are frequently performed, a vascular surgeon must be readily available.

Femoral artery and vein injury after cerclage wiring of the femur: a case report

Iatrogenic injuries to the vascular system are a rare but serious complication of primary and revision hip arthroplasty. These injuries usually occur during screw or retractor placement at the acetabulum or proximal femur. Although vascular injury during the passage of cerclage wires is a fear of all surgeons, its occurrence is yet to be described. This case report describes an unusual injury to the femoral artery and vein by a cerclage wire passed around the femoral midshaft during revision total-hip arthroplasty. It underscores the need for diligent comparison of preoperative and postoperative vascular examinations and emergent vascular surgery consultation when needed to avoid disastrous complications.

Emphysematous cystitis with venous bubbles

An 86-year-old nondiabetic woman with an episode of transient ischemic attack two days earlier was referred to our hospital. She had a history of neurogenic bladder and chronic atrial fibrillation and had been anuric for two days. Bubbles were detected by echocardiography in the right atrium, right ventricle, and inferior vena cava. Computed tomography revealed gas accumulation in the wall and lumen of the bladder. She recovered after urinary drainage and antibiotic therapy, and bubbles were no longer detected. It was suspected that bacterial injury of the bladder wall and high intravesical pressure led gas to enter the venous system.

The control of severe intraoperative bleeding using an overlay autogenous tissue (OAT) patch: case reports

BACKGROUND

Severe intraoperative bleeding cannot always be controlled by standard surgical techniques. We recently reported a new technique to repair serious vascular injury using a free graft of omentum or rectus abdominus fascia as an overlay autogenous tissue (OAT) patch in the experimental sheep model. We now describe the successful clinical use of this patch in three patients.

CASE REPORTS

Radical surgery was performed on three patients with pelvic malignancy with resulting uncontrollable bleeding from the internal iliac vein, pelvic side wall and paravaginal venous plexuses, respectively. Hemostasis was secured using an OAT patch made of abdominus rectus fascia in two cases and appendix epiploicae as an omental substitute in the other.

DISCUSSION

The utility of the OAT patch is described in three different clinical situations. It is suggested that this technique may be especially useful to gynecologic oncologists when standard surgical techniques fail to control bleeding or there is limited access to the site of injury.