Outcome of Iatrogenic Injuries to the Abdominal and Pelvic Veins

Purpose. To analyze the management and outcome of iatrogenic injuries to the abdominal and pelvic veins. Methods. We reviewed a series of patients who sustained iatrogenic vein injuries between 1989 and 2004. Results. Thirty patients (21 men and 9 women ranging in age from 38 to 82 years; mean age, 53.6 years) sustained major vein injuries during general (46%), gynecological (20%), orthopedic (13%), colorectal (10%), or urologic (10%) operations. The following veins were injured: inferior vena cava (n = 10), portal vein (n = 4), iliac vein (n = 15), and renal vein (n = 1). The following types of repair were carried out: venorrhaphy (56%), end-to-end anastomosis (10%), and an interposition graft (33%). Seven patients (23%) died of injury-related causes and 18 (60%) suffered major injury-related complications, including bleeding requiring repeat exploration (n = 7), disseminated vascular coagulopathy (DIC; n = 5), venous thrombosis (n = 4), and lower limb arterial ischemia (n = 2). There were two cases of late venous thrombosis. Conclusions. Iatrogenic vein injuries can occur during radical surgery for cancer and are associated with high morbidity and mortality as a result of massive bleeding. Rapid vascular control and venous repair improve early and late outcome.