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Nakahara Y, Kanemura T, Shimozawa M, Kawamoto S, Fukushima T, Morooka K. Sutureless Repair for Iliac Vein Bleeding Using an Elastomeric Sealant. Cureus 2024; 16:e57074. [PMID: 38681424 PMCID: PMC11050735 DOI: 10.7759/cureus.57074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Addressing venous bleeding is a frequent complication of vascular and abdominopelvic surgeries. We present a novel sutureless repair technique using HydrofitⓇ (Terumo, Tokyo, Japan), an elastomeric sealant. In a patient experiencing common iliac vein bleeding during abdominal aortic aneurysm surgery, this technique successfully achieved complete hemostasis. By applying the elastomeric sealant with an autologous arterial patch to the bleeding site, we demonstrate the simplicity and effectiveness of sutureless hemostasis for venous bleeding.
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Affiliation(s)
| | | | | | - Shuhei Kawamoto
- Cardiothoracic Surgery, IMS Katsushika Heart Center, Tokyo, JPN
| | | | - Kazuki Morooka
- Cardiothoracic Surgery, IMS Katsushika Heart Center, Tokyo, JPN
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Kalmykov EL, Gaibov AD, Nematzoda O, Sharipov MA, Baratov AK. [Some aspects of iatrogenic vessel injury]. Khirurgiia (Mosk) 2021:85-91. [PMID: 33759475 DOI: 10.17116/hirurgia202104185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Iatrogenic events made up 1-10% of in-hospital mortality. Currently, iatrogenic vascular injuries are described for almost all surgical areas. Incidence of iatrogenic vascular injuries is gradually increased that is primarily associated with high number of percutaneous endovascular interventions. Surgical treatment of patients with iatrogenic vessel injuries is extremely difficult. This is due to sudden development of this complication, severe clinical state of the patient associated with underlying disease, acute massive blood loss, as well as insufficient experience of surgeon in urgent vascular surgery. Simple lateral or circular suturing is not always possible to restore the vessel integrity. Vascular replacement including non-standard vascular reconstructions are often required. Prevention of iatrogenic vascular injuries is also insufficiently described in the literature. Most manuscripts devoted to iatrogenic vascular injuries are usually represented by case reports or small sample. Thus, it is impossible to identify the main measures for prevention of iatrogenic injury.
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Affiliation(s)
| | - A D Gaibov
- Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - O Nematzoda
- Republican Research Center for Cardiovascular Surgery, Dushanbe, Tajikistan
| | - M A Sharipov
- Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - A K Baratov
- Republican Research Center for Cardiovascular Surgery, Dushanbe, Tajikistan
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Filis K, Sigala F, Stamatina T, Georgia D, Zografos G, Galyfos G. Iatrogenic Vascular Injuries of the Abdomen and Pelvis: The Experience at a Hellenic University Hospital. Vasc Endovascular Surg 2019; 53:541-546. [DOI: 10.1177/1538574419858809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The aim of this study is to present the experience of a Vascular Division at a Hellenic University hospital concerning the management of iatrogenic vascular injuries (IVIs) of the abdomen or pelvis. Patients and Methods: This is a retrospective study evaluating all IVIs reported during a 10-year period in our institution. Only injuries warranting a vascular surgeon consultation were included in the study. Non-iatrogenic injuries were not included. Mortality and major complications within 30 days were evaluated. Results: Overall, 70 cases were recorded, with 41% being venous and 59% being arterial injuries. Iliac arteries (51%) were the most common location and rupture/lacerations (73%) were the most common type of injury. General surgery (61.5%) and cardiology (30%) procedures were the most frequently involved procedures. A 30-day mortality was 5.7%, with 30% of cases treated conservatively. Synthetic bypass grafting (odds ratio [OR] = 65.0; 95% confidence interval [CI], 4.022-1050.358; P = .003) and male gender (OR = 83.77; 95% CI, 4.040-1736.738; P = .004) were associated with death. Conclusions: Iatrogenic vascular injuries of the abdomen or pelvis are usually associated with general surgery and endovascular procedures. When vascular consultation is requested early, mortality could remain low. However, a selected number of stable patients with retroperitoneal or pelvic hematomas could be treated conservatively, yielding satisfying results.
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Affiliation(s)
- Konstantinos Filis
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fragiska Sigala
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Triantafyllou Stamatina
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Doulami Georgia
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Zografos
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Galyfos
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kakkos SK, Tsolakis IA, Markopoulos G, Maroulis I, Koletsis E, Fligou F, Panagopoulos K, Papadoulas S, Lampropoulos G, Ntouvas I, Nikolakopoulos KM, Papageorgopoulou CP, Kouri A. Presentation patterns and prognosis of 109 isolated venous injuries in 99 patients. Phlebology 2019; 34:698-706. [DOI: 10.1177/0268355519837870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To identify outcome predictors of isolated venous injuries (VIs). Methods Retrospective analysis of prospectively collected information. Results A total of 99 patients with 109 isolated VI were included. All-cause mortality was 18/99 (18%) and mortality related to the VI was 10/99 (10%). On multivariate analysis, independent predictors of all-cause mortality included age (odds ratio – OR – 1.06, p = 0.042), external cause – trauma and foreign body retention – of VI (OR 34.62, p = 0.002) and the number of red blood cell units transfused intraoperatively (OR 2.10, p < 0.001), while independent predictors of VI-related mortality included external cause of VI (OR 47.60, p = 0.001) and the number of red blood cell units transfused intraoperatively (OR 1.72, p = 0.003). Conclusions VIs due to external causes have a high mortality rate. On the other hand, VIs due to internal causes (iatrogenic injuries during a surgical procedure) are managed promptly and have a very low mortality related to the VI.
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Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Ioannis A Tsolakis
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - George Markopoulos
- Department of Surgery, University of Patras Medical School, Patras, Greece
| | - Ioannis Maroulis
- Department of Surgery, University of Patras Medical School, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University of Patras Medical School, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and Intensive Care, University of Patras Medical School, Patras, Greece
| | | | - Spyros Papadoulas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - George Lampropoulos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Ioannis Ntouvas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | | | | | - Anastasia Kouri
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
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Hans SS, Vang S, Sachwani-Daswani G. Iatrogenic Major Venous Injury Is Associated with Increased Morbidity of Aortic Reconstruction. Ann Vasc Surg 2018; 47:200-204. [DOI: 10.1016/j.avsg.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/13/2017] [Accepted: 08/03/2017] [Indexed: 10/18/2022]
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Mansukhani NA, Havelka GE, Helenowski IB, Rodriguez HE, Hoel AW, Eskandari MK. The enduring patency of primary inferior vena cava repair. Surgery 2017; 161:1414-1422. [PMID: 28011005 PMCID: PMC5404996 DOI: 10.1016/j.surg.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/19/2016] [Accepted: 11/05/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inferior vena cava repair after planned and unplanned venotomy is performed by either interposition bypass, patch venopasty, or lateral venorrhaphy and primary repair. Primary repair of the inferior vena cava avoids the use of foreign material and allows an all-autologous repair in an expeditious fashion. The purpose of this study was to demonstrate the utility of inferior vena cava repair, determine the degree of inferior vena cava stenosis, and examine clinical outcomes after primary repair. METHODS We conducted a single-center retrospective review of patients who underwent primary inferior vena cava repairs between January 2002 and January 2014 at a tertiary care center. Primary repair followed lateral venorrhaphy for tumor extraction or for repair of an iatrogenic inferior vena cava injury. Patient demographics, cross-sectional vena cava dimensions, and patient outcomes were tabulated. RESULTS In total, 47 (30 men and 17 women) patients underwent primary inferior vena cava repair (median age 58 years, range 31-83 years). Twenty-six patients (15 men and 11 women) underwent en bloc radical nephrectomy, inferior vena cava tumor thrombus extraction, and primary lateral venorrhaphy (median age 61 years, range 39-83 years). The majority, 92% of these patients, had renal cell carcinoma on final pathology, with a median follow-up period of 39 months (range 1-108 months). Twenty-one patients (15 men and 6 women) underwent primary repair for iatrogenic inferior vena cava injury (median age 54 years, range 31-82 years). The median follow-up period was 18.5 months (3-110 months). Clinic follow-up with postoperative imaging was obtained in 76.9% of those undergoing tumor thrombus extraction (n = 20) and 76.2% of those undergoing repair of an iatrogenic injury (n = 16). Overall, there was a 13% infrarenal inferior vena cava diameter loss, 17% inferior vena cava diameter loss at the level of the renal veins, and 10% suprarenal inferior vena cava diameter loss when comparing postoperative with preoperative imaging. All patients remained asymptomatic; therefore, inferior vena cava narrowing associated with primary repair was clinically insignificant. CONCLUSION Primary inferior vena cava repair is associated with less than 20% inferior vena cava diameter loss and does not compromise venous outflow from the extremities. Primary inferior vena cava repair is a safe and expeditious technique that provides excellent clinical outcomes and long-term patency.
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Affiliation(s)
- Neel A Mansukhani
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - George E Havelka
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Irene B Helenowski
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heron E Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Abstract
BACKGROUND The aim was to study the nature of iatrogenic vascular injuries (IVIs) associated with postoperative death within 30 days. METHODS Patients who had undergone vascular surgery for IVIs and were reported prospectively to the Swedish national vascular registry during 1987-2008 were identified. They were cross-checked with the national population registry. Those who died within 30 days of surgery were studied regarding case records and death certificates. RESULTS A total of 56 patients with postoperative death within 30 days after IVI were identified. Among them, 52 case records were retrieved (93 %). In 24 cases the IVIs were caused by puncture during endovascular procedures (13 hemorrhage, 11 occlusive thrombosis), 11 by penetrating trauma during open surgery, 6 by occlusion after external compression, 6 by percutaneous accidental arterial puncture. Main symptoms were peripheral ischemia (19/52, 37 %), external bleeding (14, 27 %), and hypovolemic shock without external bleeding (10, 19 %). Main specialties involved were interventional radiology (n = 18), general surgery (n = 9), and interventional cardiology (n = 8). Overall, 22 (42 %) were avoidable, and only 13 (25 %) underwent autopsy. Within 2 weeks, 36 patients (69 %) were dead. Also, there was a higher proportion with uncertain correlation between IVI and death. CONCLUSIONS Interventional radiology, general surgery, and cardiology are the main specialities involved in IVIs with lethal outcome. Not all fatalities after IVI are attributable to the injury itself, but almost half of the injuries were considered avoidable.
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Affiliation(s)
- H Rudström
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 751 85 Uppsala, Sweden.
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Yoo TK, Min SK, Ahn S, Kim SY, Min SI, Park YJ, Ha J, Kim SJ. Major Vascular Injury During Nonvascular Surgeries. Ann Vasc Surg 2012; 26:825-32. [DOI: 10.1016/j.avsg.2012.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/29/2011] [Accepted: 01/11/2012] [Indexed: 10/28/2022]
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Khalafallah A, Jarvis C, Morse M, Albarzan AM, Stewart P, Bates G, Hayes R, Robertson I, Seaton D, Brain T. Evaluation of the innovance d-dimer assay for the diagnosis of disseminated intravascular coagulopathy in different clinical settings. Clin Appl Thromb Hemost 2012; 20:91-7. [PMID: 22859588 DOI: 10.1177/1076029612454936] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Disseminated intravascular coagulopathy (DIC) is a serious disease with fatal consequences. We prospectively analyzed Innovance d-dimer immunoturbidimetric assay in 68 patients diagnosed with DIC on the background of malignancy (22), severe infection (20), or multitrauma (26) at a single institution between January 2010 and January 2011. Median age was 61 years (range 20-89). All patients were assessed according to the International Society of Thrombosis and Haemostasis (ISTH) DIC score. Applying a threshold of Innovance d-dimer of 10 mg/L fibrinogen equivalent unit (normal <0.5) was correlated with the highest sensitivity in malignancy (86%) and trauma/surgery (80%) compared to 54% in infection. The specificity remained high at 97% in infection, 81% in trauma and 77% in malignancy with a negative predictive value of 97% in trauma and malignancy, and 88% in infection. Our data suggest that Innovance d-dimer is a useful and simple tool that enhances the ISTH DIC diagnostic criteria. Further studies to confirm these findings are warranted.
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Affiliation(s)
- Alhossain Khalafallah
- 1Department of Pathology and Haematology, Launceston General Hospital, Launceston, Tasmania, Australia
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Willaert W, Van Herzeele I, Ceelen W, Van De Putte D, Vermassen F, Pattyn P. Endovascular treatment of an iatrogenic perforation of the internal iliac vein. Ann Vasc Surg 2012; 26:733.e1-4. [PMID: 22664295 DOI: 10.1016/j.avsg.2011.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/10/2011] [Accepted: 08/11/2011] [Indexed: 11/28/2022]
Abstract
We describe the case of a 48-year-old woman who developed a pelvic abscess after extensive surgery for recurrent ovarian cancer. While draining the abscess, a massive venous bleeding occurred. The bleeding was controlled by introducing a Foley catheter transrectally, occluding the perforated internal iliac vein. However, the catheter was positioned unintentionally in the inferior vena cava, causing hemodynamic instability. The iatrogenic perforation of the internal iliac vein was managed successfully with an endovascular approach using thrombin in combination with balloon-induced thrombosis. If iatrogenic venous bleeding occurs and the placement of a stent is precluded, balloon-induced thrombosis in combination with thrombin injection can be used successfully.
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Affiliation(s)
- Wouter Willaert
- Department of Surgery, Ghent University Hospital, Ghent, Belgium.
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Xiong J, Liu M, Guo W, Liu X, Yin T, Jia X, Wang L, Ma X, Zhang H. A retrospective study on endovascular management of iatrogenic vascular injuries. Vascular 2012; 20:65-71. [PMID: 22490785 DOI: 10.1258/vasc.2011.oa0327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate the outcome of endovascular management of iatrogenic vascular injuries (IVIs). We retrospectively reviewed the clinical records of 19 consecutive patients who underwent endovascular therapy of IVIs. Endograft implantation was conducted in 13 patients, intravascular embolization using coil was performed in four patients, combined treatment involving endovascular balloon intervention and percutaneous thrombin injection was done in one patient and the remaining one patient received balloon compression for hemostasis. There were no deaths after the operation. In the patients with vessel rupture ( n = 9) or perforation ( n = 4), cessation of bleeding and restoration of blood flow were achieved following the endovascular treatments. Four cases of pseudoaneurysm and one case of arteriovenous fistula were successfully eliminated. At a median follow-up of 23.8 months (range 4–84), one patient suffered a mild cerebral infarction secondary to covered stent placement and one patient developed a partial renal infarction secondary to coil embolization. Additionally, stent collapse was found in one patient with stenosis of the iliofemoral vein, accounting for the failure to resolve the lower limb edema. In conclusion, endovascular therapy is an effective technique in the management of different types of IVIs, but is associated with minor ischemic complications.
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Affiliation(s)
- Jiang Xiong
- Department of Vascular Surgery, Clinical Division of Surgery, Chinese PLA General Hospital and Postgraduate Medical School, Beijing, People's Republic of China
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