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Iatrogenic vascular injuries in Sweden. A nationwide study 1987-2005
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
2008 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 35, no 2, 131-138 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. To study the epidemiology of vascular injuries, with special focus on Iatrogenic Vascular Injuries (IVIs) and time-trends.

Design and methods. From the Swedish national vascular registry, Swedvasc, prospectively registered data on vascular injuries during 1987-2005 were analysed and cross-referenced for mortality against the population registry.

Results. Of 1853 injuries, 48% were caused by iatrogenic, 29% penetrating and 23% blunt trauma. In the three groups median age was 68, 35 and 40 years, respectively. The annual incidence of procedures for vascular injuries increased from 1.2-1.6 per 100 000 inhabitants and the proportion of IVIs increased from 41 to 51%, during the period. Mortality was higher after IVI (4.9%) compared to non-IVI (2.5%). Patients with IVI also had more co-morbidities; 58% cardiac disease, 44% hypertension, and 18% renal dysfunction.

Among 888 IVIs, right femoral arterial injury was the most frequent (37%). The most common vascular reconstruction was direct suture (39%) followed by by-pass or interposition graft (19%, of which prosthetics were used in over half the cases). Endovascular repair increased from 4.6% to 15% between 1987 and 2005.

Conclusions. Vascular injuries, in particular iatrogenic ones, appear to be increasing. Iatrogenic injuries affect vulnerable patients with co-morbidities and are associated with a high mortality.

Place, publisher, year, edition, pages
2008. Vol. 35, no 2, 131-138 p.
Keyword [en]
iatrogenic, vascular injury, arterial injury, vascular trauma
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-16609DOI: 10.1016/j.ejvs.2007.09.010ISI: 000253380400002PubMedID: 17996467OAI: oai:DiVA.org:uu-16609DiVA: diva2:44380
Available from: 2008-05-29 Created: 2008-05-29 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Iatrogenic Vascular Injuries
Open this publication in new window or tab >>Iatrogenic Vascular Injuries
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Iatrogenic vascular injuries (IVIs) and injuries associated with vascular surgery can cause severe morbidity and death. The aims of this thesis were to study those injuries in the Swedish vascular registry (Swedvasc), the Swedish medical injury insurance where insurance claims are registered, the Population and Cause of death registries, and in patient records, in order to explore preventive strategies.

Among 87 IVIs during varicose vein surgery 43 were venous, mostly causing bleeding in the groin. Among 44 arterial injuries, only 1/3 were detected intraoperatively. Accidental arterial stripping predominated, with poor outcome. Four patients died, all after venous injuries.

IVIs increased over time, and constitute more than half of the vascular injuries registered in the Swedvasc. Lethal outcome was more common (4.9%) among patients suffering IVIs than among non-iatrogenic vascular injuries (2.5%). Risk factors for death were age, diabetes, renal insufficiency and obstructive lung-disease.

Fifty-two patients died within 30 days after IVI. The most common lethal IVIs were puncture during endovascular procedures (n=24, 46%), penetrating trauma during open surgery (11) and occlusion after compression (6). Symptoms were peripheral ischemia (n=19), external bleeding (14), and hypovolemic chock without external bleeding (10). Most died within two weeks (n=36, 69%). After >2 weeks the IVI as a cause of death was uncertain.

Among 193 insurance claims after vascular surgery during 2002-2007, nerve injuries (91) and wound infections (22) dominated. Most patients suffered permanent injuries, three died. Patients with insurance claims were correctly registered in the Swedvasc in 82%.

In 32 cases of popliteal artery injury during knee arthroplasty symptoms were bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Only twelve injuries (38%) were detected intraoperatively. Patency at 30 days was 97%, but only seven (22%) patients had complete recovery. Six of those had intraoperative diagnosis of popliteal injury and immediate vascular repair.

In conclusion, registration of IVIs is increasing and outcome is often negatively affected by diagnostic and therapeutic delay. Not all fatalities after IVIs are attributable to the injury itself. The most common causes of insurance claims after vascular surgery were nerve injuries, and 82% were correctly registered in Swedvasc.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 63 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 867
Keyword
vascular injuries, vascular surgery, vascular trauma, injury, medical error, patient safety, postoperative death, postoperative mortality, patient insurance, varicose veins
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-194346 (URN)978-91-554-8597-9 (ISBN)
Public defence
2013-04-12, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-03-22 Created: 2013-02-12 Last updated: 2013-04-02Bibliographically approved

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Rudström, HåkanBergqvist, DavidÖgren, MatsBjörck, Martin

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