Vascular surgical intervention for complications of cardiovascular radiology: 13 years' experience in a single centre

This study investigates incidence and outcome of iatrogenic vascular compli cations needing surgery in a single vascular unit serving interventional va scular radiology and interventional cardiology. Evolution of diagnostic and interventional cardiovascular radiology, along with the introduction of no n-surgical therapies for such complications, may have influenced the number of vascular complications requiring emergency surgery. Vascular surgical data were collected from information prospectively entere d on computerised database and case note review. Radiology data were collat ed from prospective entries in logbooks and computerised database. In all 24 033 cardiovascular radiological procedures were performed between 1984 and 1996 (61% cardiac), numbers increasing annually. During this peri od, 62 patients (40 peripheral; 22 cardiac) required emergency surgical int ervention after radiological procedures. Mean age was 61.9 years (range 1-9 2 years), male to female ratio was 1:1. The absolute number of cases requir ing surgical intervention peaked in 1989, subsequently reducing annually. S ites of vascular injury included common femoral artery (40), brachial arter y (6), iliac artery (6), popliteal artery (5), other (5). A total of 87 vas cular surgical operations was performed (range 1-6 operations per patient). Interventions included thrombectomy/embolectomy (29), bypass grafting (16) , direct repair (27). Seven major amputations were performed (two bilateral ). Mortality after surgery was 9.7%. Mean inpatient hospital stay was 11.3 days (range 0-75 days). A Poisson regression model indicates a 5% reduction in risk for each successive year of observation; however, this did not rea ch statistical significance (P=0.16, 95% CI 12% decreased risk to 2% increa sed risk). The risk of surgical intervention after diagnostic or interventional cardio vascular radiology is diminishing but still requires vigilance. Necessity f or surgical intervention is associated with a high risk of morbidity and mo rtality.