Iatrogenic vascular injuries in Sweden. A nationwide study 1987-2005.

ABSTRACT

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 mortality against 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.