Iatrogenic operative injuries of abdominal and pelvic veins: A potentially lethal complication

Gustavo S. Oderich, Jean M. Panneton, Jan Hofer, Thomas C. Bower, Kenneth J. Cherry, Timothy Sullivan, Audra A. Noel, Manju Kalra, Peter Gloviczki, Donald Spadone, William Turnipseed, Robert Mclafferty, Kirsh Soundararajam

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Purpose: Epidemiologic studies of vascular injuries are usually limited to those caused by trauma. The purpose of this study was to review the management and clinical outcome in patients with operative injuries to abdominal and pelvic veins. Methods: Clinical data and outcome in all patients with iatrogenic venous injuries during abdominal and pelvic operations between 1985 and 2002 were reviewed. Results: Forty patients (21 men, 19 women; mean age, 51 years [range, 27-87 years]) sustained 44 venous injuries. Injuries occurred during general (30%), colorectal (23%), orthopedic (20%), gynecologic (15%), and other (12%) operations. Factors leading to injury included oncologic resection (65%), difficult anatomic exposure (63%), previous operation (48%), recurrent tumor (28%), and radiation therapy (20%). All patients had substantial bleeding (mean, 3985 mL; range, 500-20,000 mL). Injuries were located in the inferior vena cava (n = 6), portal vein (n = 7), renal vein (n = 1), and iliac vein (n = 30). Repair was performed with venorrhaphy (64%), end-to-end anastomosis (14%), interposition graft (20%), and vessel ligation (2%). Seven patients (18%) died of injury-related causes, including multisystem organ failure (n = 4), uncontrollable bleeding (n = 2), and pulmonary embolism (n = 1). Thirteen patients (32.5%) had major injury-related complications, including repeat exploration because of bleeding (n = 6), multisystem organ failure (n = 6), and venous thrombosis (n = 4). In two patients (5%) unilateral lower extremity edema developed, with no evidence of thrombosis. There was no late graft or venous thrombosis. Variables associated with increased risk for death were massive bleeding, acidosis, hypotension, and hypothermia (P <.05). Conclusion: Operative injuries of abdominal and pelvic veins occur in patients undergoing oncologic resection and those with difficult anatomic exposure, owing to previous operation, recurrent tumor, or radiation therapy. Massive blood loss, acidosis, hypotension, and hypothermia are associated with increased risk for death. Repair of venous injuries offers durable results with low incidence of graft or venous thrombosis.

Original languageEnglish (US)
Pages (from-to)931-936
Number of pages6
JournalJournal of Vascular Surgery
Volume39
Issue number5
DOIs
StatePublished - May 2004
Externally publishedYes

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Abdominal Injuries
Veins
Wounds and Injuries
Venous Thrombosis
Hemorrhage
Acidosis
Hypothermia
Transplants
Hypotension
Radiotherapy
Iliac Vein
Renal Veins
Vascular System Injuries
Inferior Vena Cava
Portal Vein
Pulmonary Embolism
Orthopedics
Ligation
Epidemiologic Studies
Lower Extremity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Oderich, G. S., Panneton, J. M., Hofer, J., Bower, T. C., Cherry, K. J., Sullivan, T., ... Soundararajam, K. (2004). Iatrogenic operative injuries of abdominal and pelvic veins: A potentially lethal complication. Journal of Vascular Surgery, 39(5), 931-936. https://doi.org/10.1016/j.jvs.2003.11.040

Iatrogenic operative injuries of abdominal and pelvic veins : A potentially lethal complication. / Oderich, Gustavo S.; Panneton, Jean M.; Hofer, Jan; Bower, Thomas C.; Cherry, Kenneth J.; Sullivan, Timothy; Noel, Audra A.; Kalra, Manju; Gloviczki, Peter; Spadone, Donald; Turnipseed, William; Mclafferty, Robert; Soundararajam, Kirsh.

In: Journal of Vascular Surgery, Vol. 39, No. 5, 05.2004, p. 931-936.

Research output: Contribution to journalArticle

Oderich, GS, Panneton, JM, Hofer, J, Bower, TC, Cherry, KJ, Sullivan, T, Noel, AA, Kalra, M, Gloviczki, P, Spadone, D, Turnipseed, W, Mclafferty, R & Soundararajam, K 2004, 'Iatrogenic operative injuries of abdominal and pelvic veins: A potentially lethal complication', Journal of Vascular Surgery, vol. 39, no. 5, pp. 931-936. https://doi.org/10.1016/j.jvs.2003.11.040
Oderich, Gustavo S. ; Panneton, Jean M. ; Hofer, Jan ; Bower, Thomas C. ; Cherry, Kenneth J. ; Sullivan, Timothy ; Noel, Audra A. ; Kalra, Manju ; Gloviczki, Peter ; Spadone, Donald ; Turnipseed, William ; Mclafferty, Robert ; Soundararajam, Kirsh. / Iatrogenic operative injuries of abdominal and pelvic veins : A potentially lethal complication. In: Journal of Vascular Surgery. 2004 ; Vol. 39, No. 5. pp. 931-936.
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T2 - A potentially lethal complication

AU - Oderich, Gustavo S.

AU - Panneton, Jean M.

AU - Hofer, Jan

AU - Bower, Thomas C.

AU - Cherry, Kenneth J.

AU - Sullivan, Timothy

AU - Noel, Audra A.

AU - Kalra, Manju

AU - Gloviczki, Peter

AU - Spadone, Donald

AU - Turnipseed, William

AU - Mclafferty, Robert

AU - Soundararajam, Kirsh

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N2 - Purpose: Epidemiologic studies of vascular injuries are usually limited to those caused by trauma. The purpose of this study was to review the management and clinical outcome in patients with operative injuries to abdominal and pelvic veins. Methods: Clinical data and outcome in all patients with iatrogenic venous injuries during abdominal and pelvic operations between 1985 and 2002 were reviewed. Results: Forty patients (21 men, 19 women; mean age, 51 years [range, 27-87 years]) sustained 44 venous injuries. Injuries occurred during general (30%), colorectal (23%), orthopedic (20%), gynecologic (15%), and other (12%) operations. Factors leading to injury included oncologic resection (65%), difficult anatomic exposure (63%), previous operation (48%), recurrent tumor (28%), and radiation therapy (20%). All patients had substantial bleeding (mean, 3985 mL; range, 500-20,000 mL). Injuries were located in the inferior vena cava (n = 6), portal vein (n = 7), renal vein (n = 1), and iliac vein (n = 30). Repair was performed with venorrhaphy (64%), end-to-end anastomosis (14%), interposition graft (20%), and vessel ligation (2%). Seven patients (18%) died of injury-related causes, including multisystem organ failure (n = 4), uncontrollable bleeding (n = 2), and pulmonary embolism (n = 1). Thirteen patients (32.5%) had major injury-related complications, including repeat exploration because of bleeding (n = 6), multisystem organ failure (n = 6), and venous thrombosis (n = 4). In two patients (5%) unilateral lower extremity edema developed, with no evidence of thrombosis. There was no late graft or venous thrombosis. Variables associated with increased risk for death were massive bleeding, acidosis, hypotension, and hypothermia (P <.05). Conclusion: Operative injuries of abdominal and pelvic veins occur in patients undergoing oncologic resection and those with difficult anatomic exposure, owing to previous operation, recurrent tumor, or radiation therapy. Massive blood loss, acidosis, hypotension, and hypothermia are associated with increased risk for death. Repair of venous injuries offers durable results with low incidence of graft or venous thrombosis.

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