Vascular injuries in the surgical management of gynaecological malignancies

From 1989 to 1991 we performed 184 radical gynaecological interventions. In the vast majority of the cases lymph node dissection was part of the procedure. Thirteen out of the 184 patients suffered vascular injury, accounting 7% complication rate. The sites of the injured vessels included the external iliac artery in four patients, the vena cava in three, the external iliac vein in five and the femoral vein in one patient. All of them were primarily sutured; no prosthesis or venous patch was needed. In four cases postoperative complications occurred in relation to vascular surgery: two deep thrombosis of the femoral vein and two occlusions of the external iliac artery. The latter two patients had permanent sequelae, i.e. difficulties in walking. Our study suggests that vascular injuries represent an utmost important intraoperative risk in the course of lymph node dissection in gynaecological malignancies. Thus, gynaecological surgeons performing radical operations must be prepared to deal with the problem.