External Iliac Artery Injury and Thrombosis during Laparoscopic Gynecologic Surgery

Abstract

Although vascular injury during laparoscopic surgery is rare, it is occasionally reported. Previously, several physicians have reported cases of compartment syndrome resulting from a thrombus during gynecologic surgery. However, few reports describe thrombosis occurring in artery vessels as a result of applying angiopressure. Herein, we report the case of a 53-year-old woman with endometrioid carcinoma and a vascular injury that resulted in thrombus formation; this is the first such case to be reported. The complication was successfully treated by means of direct anastomosis following partial resection of the injured iliac artery. This is the first report of a case in which applying angiopressure for a vascular injury during laparoscopic pelvic lymphadenectomy led to an intra-arterial thrombus which was found and treated without sequelae.

Postoperative arterial thromboembolism resulting in acute limb ischemia after staging surgery for endometrial carcinoma: A case report

“…Risk factors discussed in the literature include but are not limited to atherosclerotic disease, embolism from the heart, prolonged surgical positioning and trendelenburg, intravascular dehydration, hyper-coagulopathy, dissection, and vascular trauma 13 . In the medical literature, 9 case reports have previously described pelvic surgeries complicated by acute limb ischemia, 6 of which were in the setting of gynecologic malignancies ( Sahara et al, 2019 , Yeon et al, 2017 , Nakamura et al, 2008 , Ishikawa et al, 2020 , Hamilton and Robinson, 1996 ); ( Table 1 ).…”

“…Postoperative arterial thrombi are exceedingly rare after laparoscopic surgery and are only noted in scant case reports, mainly in patients with preexisting hematologic disorders, severe arteriosclerotic disease, or prior radiation therapy. Specifically in patients with gynecological cancer, there are less than 10 reported cases of acute postoperative arterial thromboembolic events in the current literature ( Levenback et al, 1996 , Nakamura et al, 2008 , Ishikawa et al, 2020 , Hamilton and Robinson, 1996 ) ( Table 1 ).…”

“… Author Year Age BMI Diagnosis Surgery Chemotherapy Lesion POD Treatment Compartment syndrome? Hamilton & Robinson ( Ishikawa et al, 2020 ) 1996 58 n/a IIIC tubal carcinoma Primary cytoreduction (open) Cisplatin, cyclophosphamide NS (R hand and wrist) 20 Amputation No 1996 78 n/a Vulvar carcinoma Radical excision, superficial inguinal lymphadenectomy n/a Microemboli (L toe, R digits) 16 Amputation No 1996 n/a n/a IIIC ovarian carcinoma Primary cytoreduction (open) n/a NS (R foot) 2 Therapeutic anticoagulation No Nakamura, et al ( Levenback et al, 1996 ) 2008 34 22 IIIC endometrial carcinoma TAH, BSO, pelvic and para-aortic lymphadenectomy n/a L common iliac 1 Thrombectomy Yes Yeon, et al ( Creager et al, 2012 ) 2017 37 22 IB2 cervical carcinoma TLH, BSO, pelvic and para-aortic lymphadenectomy n/a L external iliac 1 Thrombectomy Yes Ishikawa, et al ( Nakamura et al, 2008 ) 2020 53 n/a IA endometrial carcinoma TLH, BSO, pelvic lymphadenectomy n/a R external iliac* 1 Thrombectomy No Tounsi et al 2021 62 42 IB e...…”

Pelvic Lymphadenectomy in Gynecologic Oncology—Significance of Anatomical Variations

“…Gyimadu et al concluded that the occurrence of vascular injuries during the course of PLNDGO may be due to variations in the anatomy of great retroperitoneal vessels. In medical literature the frequency of such abnormalities varies between 5.6 and 23.0% [ 64 , 65 , 66 , 67 , 68 ].…”