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Online ISSN 1827-1707
Oktar G. L. 1, Gungor S. 2, Ergul E. G. 1, Gelisen M. I. 1, Karakas A. 2, Arikan M. 2
1 Division of Cardiovascular Surgery Ankara Oncology Training and Research Hospital Ankara, Turkey
2 Department of Orthopedics Ankara Oncology Training and Research Hospital Ankara, Turkey
Aim. Iatrogenic vascular injuries may occur in orthopedic cancer surgery, although the surgical procedure can be planned well preoperatively and carried out in an interdisciplinary fashion. This retrospective study was conducted to review the incidence, pattern, management and outcome of iatrogenic arterial injuries associated with orthopedic cancer surgery.
Methods. Nine hundred and ninety-eight pa-tients who underwent orthopedic tumor resection procedures were reviewed. Twenty-two patients with iatrogenic operative arterial injuries associated with orthopedic cancer surgery were included in the study.
Results. Twenty-two arterial and 6 concomitant venous injuries were identified. Eleven (50%) patients had osteosarcoma. The two most common arteries injured were superficial femoral and popliteal arteries in 7 (31.8%) patients. Twelve of arterial injuries (54.5%) were repaired primarily or with end-to-end anastomosis, while the remaining injuries required thrombectomy, interposition, bypass grafts, patch angioplasty or combined procedures. All venous injuries were repaired primarily. No perioperative deaths were observed. Postoperative revision procedures were performed in 5 patients (22.7%). Three patients required an eventual amputation and one had loss of extremity function.
Conclusions. Iatrogenic arterial injury is more common in orthopedic cancer surgery. Pre-vious operation and atherosclerotic vascular disease or risk factors for atherosclerosis may be considered as predisposing factors for iatrogenic arterial injury. Serious complications can be minimized by immediate recognition and prompt repair of the injuries. A vascular surgeon needs to be available in hospitals where orthopedic tumor resection procedures are frequently performed.