Narrative review of vascular iatrogenic trauma and endovascular treatment

Abstract

Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.

Iatrogenic Abdominal Aortic Rupture During Transpedicular Bone Grafting for Thoracolumbar Burst Fractures Successfully Treated by Endovascular Stent Implantation

“…10 In our case, the prone position ensured that the abdominal structures became pressed against the vertebral bodies, rendering the retroperitoneal vessels fixed in close proximity to the anterior longitudinal ligament. 12 In addition, from the imaging point of view, the calcification of the patient’s aorta was very severe, making the vessel less elastic, and the anterior edge of the L2 vertebral body was ruptured. Most importantly, the end of the bone grafting funnel is sharp.…”

“…10 Minimally invasive endovascular techniques have been used increasingly as an alternative treatment modality to conventional open surgical repair because of their low morbidity and mortality. 12,13 However, the hemodynamic stability of the patient, any associated comorbidities and concomitant injuries, and the suitability of the vascular anatomy for endovascular repair should all be assessed as part of patient selection. 14 Open surgery is still the best option for patients with unstable vital signs, and an endovascular approach can be applied to stable patients.…”

Iatrogenic Vascular Injuries: A Review

“…Patient outcomes can be improved by prompt identification of iatrogenic damage and proper triage for additional treatment. For individuals with IVI, minimally invasive endovascular therapy may be an alternative [31].…”

“…Regardless of the controversy surrounding whether or not angiograms are necessary for penetrating injuries to the extremities, there are many more situations in which angiography is obviously required. Clearly, angiography is necessary before endovascular therapy [27,31]. Endovascular and minimally invasive procedures are increasingly used in the transitional stage of vascular surgery.…”

Arteriovenous Fistula: The Case of a Rare Complication after Minimal Percutaneous Nephrostomy and Brief Review

“…The complications of this method are those associated with any minimally invasive surgical procedure: vascular injury, damage to nearby organs, and infection [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. The Society of Cardiovascular and Interventional Radiology and the American College of Radiology have shown that percutaneous nephrostomy is associated with less than 4% major bleeding or septic shock [ 17 ].…”