Iatrogenic Vascular Injuries in Sweden. A Nationwide Study 1987–2005☆

Objectives

To study the epidemiology of vascular injuries, with special focus on Iatrogenic Vascular Injuries (IVIs) and time-trends.

Design and methods

From the Swedish national vascular registry, Swedvasc, prospectively registered data on vascular injuries during 1987–2005 were analysed and cross-referenced for mortalityagainst the population registry.

Results

Of 1853 injuries, 48% were caused by iatrogenic, 29% penetrating and 23% blunt trauma. In the three groups median age was 68, 35 and 40 years, respectively. The annual incidence of procedures for vascular injuries increased from 1.2–1.6 per 100 000 inhabitants and the proportion of IVIs increased from 41 to 51%, during the period. Mortality was higher after IVI (4.9%) compared to non-IVI (2.5%). Patients with IVI also had more co-morbidities; 58% cardiac disease, 44% hypertension, and 18% renal dysfunction.

Among 888 IVIs, right femoral arterial injury was the most frequent (37%). The most common vascular reconstruction was direct suture (39%) followed by by-pass or interposition graft (19%, of which prosthetics were used in over half the cases). Endovascular repair increased from 4.6% to 15% between 1987 and 2005.

Conclusions

Vascular injuries, in particular iatrogenic ones, appear to be increasing. Iatrogenic injuries affect vulnerable patients with co-morbidities and are associated with a high mortality.

Keywords: Iatrogenic, Vascular injury, Arterial injury, Vascular trauma