Sachinder S. Hans, Gul Sachwani-Daswani
St. John Macomb, Warren, MI.
OBJECTIVES: Major venous injury during open Aortic reconstruction is uncommon but can negatively impact its results. Few studies document early and late results of such injuries; this was the aim of this study.
METHODS: From 1981-2012, 1,217 patients underwent aortic reconstructions, open abdominal aortic aneurysm (AAA)/iliac aneurysm repair in 764 (130 ruptured/634 intact). Aortofemoral grafting (AFG) in 224 (redo 6) and endovascular AAA repair with femoral cut down in 229. Sixteen patients with major venous injury were identified (sudden loss of more than 500cc of blood). Mortality of intact AAA repair (30 days) of intact aneurysm was 3% and ruptured aneurysms were 46%, AFG 3.1% and EVAR 2.2%. All patients with iliac vein and inferior vena cava injuries had follow-up noninvasive venous exam of the lower extremity.
RESULTS: Sixteen major venous injuries occurred during aortic reconstruction. Inferior vena cava (IVC) injury 2, iliac vein 8, femoral vein 2, left renal vein (LRV) 4 (including posterior renal collar vein 1) instances. Six injuries (out of 130) occurred following ruptured AAA repair and seven injuries (out of 634) following intact AAA repair (p=0.013). Two venous injuries occurred after redo ABF and none after primary ABF (p=0.0006). Contributing factor for iliac vein injury included inflammatory AAA=2, dissection of large iliac aneurysms=3, tunneling of the graft=2 and obesity=1. Intraoperative transfusion requirements were 3 to 28 units (median 8 units). One patient died (6.2%) secondary to iliac vein injury during repair of ruptured AAA.
CONCLUSIONS: Major venous injury is more common during repair of ruptured AAA and redo AFG. Following repair of iliac/femoral vein injury, 44% of surviving patients developed iliofemoral venous thrombosis.
AUTHOR DISCLOSURES: S. S. Hans:
Nothing to disclose; G. Sachwani-Daswani:
Nothing to disclose.
Posted April 2013