Elektif Abdominal ve Pelvik Cerrahi Esnasýnda Ýatrojenik Vasküler Yaralanmalar: Retrospektif, Tek Merkez, 30 Günlük Takip Sonuçlarý

Giriþ: Nadir de olsa elektif karýn veya pelvik ameliyatlarda damar yaralanmalarýyla karþýlaþýlmaktadýr. Ýlgili arter/vende herhangi bir yaralanma olduðunda, bu durum hem kýsa hem de uzun vadede mortalite ve morbidite ile iliþkilidir. Elektif olgularda damar yaralanmalarýnda tedavi yaklaþýmýmýzý ve kýsa dönem sonuçlarýmýzý paylaþmayý amaçladýk.
Method: Bu çalýþmada Ocak 2018 ile Temmuz 2023 tarihleri arasýnda elektif karýn ve pelvik cerrahi esnasýnda olan iyatrojenik damar yaralanmasý nedeniyle damar cerrahý tarafýndan müdahale edilen hastalar retrospektif olarak incelendi.
Bulgular: Çalýþmada ürolojik cerrahi giriþim uygulanan 21 (%29,2) olguda, jinekolojik cerrahi tedavi uygulanan 35 (%48,6) olguda ve batýn cerrahisi uygulanan 16 (%22,2) olguda iyatrojenik damar yaralanmasý meydana geldi. 29 hastada izole arteriyel yaralanma, 37 hastada izole venöz yaralanma ve 6 hastada hem arter hem de ven yaralanmasý vardý. 24 hastaya embolektomi uygulandý. Hastalarýn 22'sine primer sütür, 13'üne ven grefti ile uç uca anastomoz, 11'ine dacron/PTFE ile uç uca anastomoz yapýldý. 10 hastaya nativ ven uç uca anastomozu yapýldý. 30 günlük takiplere bakýldýðýnda 3 hastada arter týkanýklýðý, 2 hastada venöz tromboz olduðu görüldü. Hastanede ve 30 günlük takipte mortalite olmadý.
Sonuç: Elektif karýn ve pelvik ameliyatlarda damar yaralanmalarý nadiren de olsa görülür. Ancak gerçekleþtiðinde mortal seyredebilir. Bu nedenle özellikle kitle eksizyonlarý ve damar yakýnlýðý olan lenf nodu diseksiyonlarýnda ameliyat öncesi multidisipliner deðerlendirme vasküler komplikasyonlarý en aza indirecektir. (SETB-2024-03-048)

Iatrogenic Vascular Injuries in Elective Abdominal and Pelvic Surgery Patients: Retrospective, Single Center, 30-Day Results

INTRODUCTION: Although rare, vascular injuries are common in elective abdominal or pelvic surgeries. When encountered, any problem in the relevant artery/vein (occlusion, stenosis, dissection, pseudoaneurysm or arteriovenous fistula) is associated with mortality and morbidity in both the short and long term. We aimed to share our treatment approach and short-term results for vascular injuries in elective surgery.
METHODS: In this study, the clinical data of patients who underwent elective abdominal and pelvic surgery performed by a vascular surgeon and who sustained iatrogenic vascular injury between January 2018 and July 2023 were retrospectively examined. All patients with no iatrogenic vascular injuries were excluded from the study.
RESULTS: In the present study, a total of 72 patients had iatrogenic vascular injuries and underwent vascular surgery. The average age of the patients was 50.8 ± 14.6 years. Twenty-eight (38.8%) of the patients were male, and 44 (61.1%) were female. Iatrogenic vascular injury occurred in 21 (29.2%) patients who underwent urologic surgical interventions, 35 (48.6%) who underwent gynecologic surgical treatments, and 16 (22.2%) who underwent abdominal surgeries. Twenty-nine patients had isolated arterial injuries, 37 patients had isolated venous injuries, and 6 patients had both arterial and vein injuries. Embolectomy was performed in 24 patients. Primary sutures were applied in 22 patients, end-to-end anastomosis with a vein graft was performed in 13 patients, and end-to-end anastomosis with Dacron/PTFE was performed in 11 patients. In 10 patients, native vein end-to-end anastomosis was performed. During the 30-day follow-up period, 3 patients experienced arterial occlusion, and 2 patients experienced venous thrombosis. There was no mortality in the hospital or during the 30-day follow-up period.
CONCLUSION: Vascular injuries rarely occur in elective abdominal and pelvic surgeries. However, when they happen, they are fatal. For this reason, preoperative, multidisciplinary evaluation will minimize the risk of vascular complications, especially in patients requiring mass excision and lymph node dissection with close vascular proximity.