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Vascular surgical intervention for complications of cardiovascular radiology: 13 years' experience in a single centre
D R Lewis1, R A Bullbulia, P Murphy
1Department of Surgery, Bristol Royal Infirmary.
Insights
Surgical intervention for iatrogenic vascular complications after cardiovascular radiology procedures is declining but remains a significant risk. Vigilance is crucial due to high morbidity and mortality associated with these vascular injuries.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiology
Background:
- Iatrogenic vascular complications requiring surgical intervention can arise from diagnostic and interventional cardiovascular radiology procedures.
- The evolution of interventional techniques and non-surgical treatments may impact the incidence of these complications.
Purpose of the Study:
- To investigate the incidence and outcomes of iatrogenic vascular complications necessitating surgical intervention following cardiovascular radiological procedures.
- To analyze trends in surgical intervention rates over time and identify associated risk factors.
Main Methods:
- Retrospective analysis of prospectively collected data from a single vascular unit.
- Inclusion of data from 24,033 cardiovascular radiological procedures performed between 1984 and 1996.
- Review of vascular surgical data, radiology logs, and computerized databases.
Main Results:
- 62 patients (40 peripheral, 22 cardiac) required emergency surgery after radiological procedures.
- The absolute number of surgical interventions peaked in 1989 and subsequently decreased.
- Common femoral artery was the most frequent site of injury (40 cases); 9.7% mortality and 11.3 days mean hospital stay were observed post-surgery.
Conclusions:
- The risk of surgical intervention for iatrogenic vascular complications is diminishing but requires continued vigilance.
- Surgical intervention for these complications is associated with substantial morbidity and mortality.
Abstract:
This study investigates incidence and outcome of iatrogenic vascular complications needing surgery in a single vascular unit serving interventional vascular radiology and interventional cardiology. Evolution of diagnostic and interventional cardiovascular radiology, along with the introduction of non-surgical therapies for such complications, may have influenced the number of vascular complications requiring emergency surgery. Vascular surgical data were collected from information prospectively entered on computerised database and case note review. Radiology data were collated from prospective entries in logbooks and computerised database. In all 24,033 cardiovascular radiological procedures were performed between 1984 and 1996 (61% cardiac), numbers increasing annually. During this period, 62 patients (40 peripheral; 22 cardiac) required emergency surgical intervention after radiological procedures. Mean age was 61.9 years (range 1-92 years), male to female ratio was 1:1. The absolute number of cases requiring surgical intervention peaked in 1989, subsequently reducing annually. Sites of vascular injury included common femoral artery (40), brachial artery (6), iliac artery (6), popliteal artery (5), other (5). A total of 87 vascular surgical operations was performed (range 1-6 operations per patient). Interventions included thrombectomy/embolectomy (29), bypass grafting (16), direct repair (27). Seven major amputations were performed (two bilateral). Mortality after surgery was 9.7%. Mean inpatient hospital stay was 11.3 days (range 0-75 days). A Poisson regression model indicates a 5% reduction in risk for each successive year of observation; however, this did not reach statistical significance (P = 0.16, 95% CI 12% decreased risk to 2% increased risk). The risk of surgical intervention after diagnostic or interventional cardiovascular radiology is diminishing but still requires vigilance. Necessity for surgical intervention is associated with a high risk of morbidity and mortality.