Iatrogenic vascular trauma

With the increasing performance of percutaneous transluminal angioplasty and insertion of an increasing number of intravascular devices, the size of arterial punctures has been increasing. A consistent minority of these procedures will result in vascular injuries requiring treatment. At the same time, the regionalized nature of trauma care in the United States has resulted in a large number of vascular surgeons who are exposed to vascular trauma only when iatrogenic. The most common injuries observed are caused by percutaneous vascular instrumentation and include hemorrhage and pseudoaneurysm that may compress adjacent structures, fistula, acute occlusion, and embolization. Injuries unique to balloon angioplasty/stenting include arterial rupture and dissection. Indwelling intravascular devices are another common source of iatrogenic vascular injury ranging from arterial rupture to thrombosis and embolization. Much less common injuries are observed in orthopedic and abdominal/laparoscopic operations but show reproducible causes/patterns. Finally, pediatric iatrogenic vascular trauma is relatively common because of the small size of the vasculature, but the natural history and management is markedly different from that in adults.