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<0.001) and were more likely to undergo re-operation after initial intervention (18% vs 6% vs 5%, p=0.005), primarily due to necessity of further repair or dialysis access revision.

Arterial thrombosis was more likely to be caused by arterial lines than pseudoaneurysm or extravasation injuries (36% vs 11% vs 13%, p<0.001). Extravasation injuries were more likely caused by trauma, than pseudoaneurysm or thrombosis (36% vs 13% vs 4%) and were more likely to undergo hematoma evacuation (50% vs 4% vs 0%, p<0.001). Extravasation had significantly shorter days from cause of injury to diagnosis (4 days vs 215 days vs 150 days, p=0.002).

Conclusions: Upper extremity iatrogenic injury occurs secondary to various causes. While operative management is often necessary to prevent long-term sequelae and morbidity, this study found that 54% of patients were successfully managed non-operatively, demonstrating the range of therapeutic approaches that can be used for upper extremity IAIs.