Iatrogenic and non-iatrogenic arterial injuries in an urban level I trauma center in Greece.

BACKGROUND

Aim of this study is to present the experience of an urban trauma center concerning the management of vascular trauma.

METHODS

All data on major arterial injuries of the extremities treated during a 6-year period (August 2008 - August 2014) were retrospectively collected and analyzed. All cases were classified into iatrogenic and non-iatrogenic injuries, and comparisons were made between the two groups. Arterial injuries of the thorax and abdomen as well as venous injuries were not included.

RESULTS

Overall, 67 major arterial injuries were managed (22% iatrogenic). Iatrogenic and non-iatrogenic cases showed differences regarding sex, age and injury of adjacent structures. Almost 8% of patients underwent primary amputation, with major nerve, long bone or extensive soft tissue injury being the main risk factors. Most iatrogenic cases underwent endovascular treatment, although open repair with venous grafting was the primary choice for non-iatrogenic injuries. Primary patency was 100% for all open repairs, although secondary patency was 97% after one month of intervention. Eight cases needed secondary amputation, with extensive soft tissue loss being the major risk factor for secondary amputation.

CONCLUSIONS

Iatrogenic and non-iatrogenic arterial injuries show different characteristics concerning epidemiology and management. Injury of main adjacent structures remains a major risk factor for primary as well as secondary amputation. Endovascular treatment when indicated remains a therapeutic choice with optimal results.