Surgery and Clinical Practice
Open AccessEtiology, Management, & Outcomes for Upper Extremity Arterial Iatrogenic Injury
Authors: Krystina N Choinski MD, Jason Storch MD, Simeret Genet BS, MA, Nour Hijazi MD, Anna B Williams BA, Peter L Faries MD, Christopher J Smolock MD, John P Phair MD
Abstract
Objective: Iatrogenic injuries, including pseudoaneurysm and thrombosis, are rare complications for upper extremity arterial interventions. Unrecognized, these complications lead to significant morbidity.Methods: Retrospective review from January 2006 to January 2022. Radiology reports including key search terms associated with arterial injury were queried. Cases with clinical suspicion of an iatrogenic injury were included. Embolic causes of acute limb ischemia were excluded. Cases were reviewed for cause, chronicity, complications, treatment, and outcomes.Results: A total of 323 upper extremity iatrogenic arterial injuries (IAIs) were identified, 171(53%) thrombosis, followed by pseudoaneurysm (85, 26%), extravasation/hematoma (39, 12%), and arterial stenosis (5, 6%). Computed tomography angiography (CTA) diagnosed 51% (163) of IAIs, while duplex ultrasound diagnosed 49% (159) of the injuries. The most injured artery was the radial artery (135, 42%), followed by the brachial (104, 32%), and axillary artery (40, 12%). Given the variety of clinical presentations, the underlying causes of injury were analyzed. Most common causes of upper extremity IAIs were arterial lines (76, 24%), cardiac procedures (66, 20%). Dialysis access complications accounted for 20% of cases, while trauma cases accounted for 12%, and vascular surgery procedures accounted for 9% of injuries.For the 150 patients who underwent intervention with 95% overall success. The majority underwent primary repair of the injured vessel (58, 39%), followed by endovascular interventions (30, 20%), including balloon angioplasty and/or stenting, and thrombin injection (19,13 %). Pseudoaneurysms were more likely to result as a complication of dialysis access rather than as a complication of thrombosis or extravasation IAIs (36% vs 11% vs 18%, p
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