Current Urology Reports

, 20:2 | Cite as

Vascular Injury During Urologic Surgery: Somebody Call My Mother

  • Javier GonzálezEmail author
  • Francisco J. Angulo-Morales
  • Enrique Lledó-García
Kidney Diseases (G Ciancio, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Kidney Diseases


Purpose of Review

To provide the critical elements to effectively manage hemorrhage from vascular injuries sustained during planned urological interventions.

Recent Findings

The frequency of intraoperative vascular injuries is increasing. However, literature concerning the management of iatrogenic operative vascular injuries is scarce.


Although rare, intraoperative vascular injuries may be associated with potential catastrophic complications and death. The decision-making process following a potential life-threatening intraoperative vascular injury occurs in a very short time frame. Appropriate knowledge of the critical elements to identify the source of bleeding, initiate first-line hemostatic measures, select the candidate for damage control strategies, and perform the indicated operative repairing maneuvers and techniques have been proved crucial to ensure hemodynamic stability and bleeding cessation. The key surgical principles to counteract the impact of exsanguinating bleeding, and the aim to obtain the best achievable outcomes after definitive repair, are described in detail in this review.


Urologic surgery Vascular injury Hemorrhage Vascular exposure Damage control 


Compliance with Ethical Standards

Conflict of Interest

Javier González, Francisco J. Angulo-Morales, and Enrique Lledó-García each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Oderich GS, Panneton JM, Hofer J, Bower TC, Cherry KJ, Sullivan T, et al. Iatrogenic operative injuries of abdominal and pelvic veins: A potentially lethal complication. J Vasc Surg. 2004;39:931–6 One of the most complete and well-described series in this context.CrossRefGoogle Scholar
  2. 2.
    •• Lundy S, Krishnamurthi V. Management of vascular complications in Urology. In: Taneja S, Shah O, editors. Complications of Urologic Surgery: Prevention and management. 5th ed. Philadelphia: Saunders Elsevier; 2017. p. 112–25. Probably the best review of the literature to date in intraoperative vascular complications.Google Scholar
  3. 3.
    Schwartz AM. The historical development of methods of hemostasis. Surgery. 1958;44:604–10.PubMedGoogle Scholar
  4. 4.
    Hallowell. Extract of a letter from Mr. Lambert, surgeon at Newcastle upon Tyne, to Dr. Hunter, giving an account of new method of treating an aneurysm. Med Obser Inq 1762. 1759;30:360.Google Scholar
  5. 5.
    Esmarch F. The surgeon’s handbook of the treatment of the wounded in war. New York: LW Schmidt; 1878.Google Scholar
  6. 6.
    Jassinowsky A. Die arteriennhat: eine experimentelle studie. Inaug Diss Dorpat. 1889.Google Scholar
  7. 7.
    Murphy JB. Resection of arteries and veins injured in continuity end-to-end suture. Exp Clin Res Med Rec. 1897;51:73–104.Google Scholar
  8. 8.
    Carrel A, Guthrie CC. Uniterminal and biterminal venous transplantations. Surg Gynecol Obstet. 1906;2:266–86.Google Scholar
  9. 9.
    Halsted WS. The effect of ligation of the common iliac artery on the circulation and function of the lower extremity. Report of a cure of iliofemoral aneurysm by the application of an aluminum band to the vessel. Bull Johns Hopkins Hosp. 1912;23:191–220.Google Scholar
  10. 10.
    DeBakey ME, Simeone FA. Battle injuries of the arteries in World War II: an analysis of 2471 cases. Ann Surg. 1946;123:534–79.CrossRefGoogle Scholar
  11. 11.
    Hughes CW. Arterial repair during the Korean War. Ann Surg. 1958;147:555–61.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1000 cases. J Trauma. 1970;10:359–69.CrossRefGoogle Scholar
  13. 13.
    Cohen A, Baldwin JN, Grant RN. Problems in the management of battlefield vascular injuries. Am J Surg. 1969;118:526–30.CrossRefGoogle Scholar
  14. 14.
    Fox CJ, Gillespie DL, O’Donnell SD, et al. Contemporary management of wartime vascular trauma. J Vasc Surg. 2005;41:638–44.CrossRefGoogle Scholar
  15. 15.
    Sarker SS, Vincent C. Errors in surgery. Int J Surg. 2005;3:75–81.CrossRefGoogle Scholar
  16. 16.
    Fingerhut A, Leppaniemi AK, Androulakis GA, Archodovassalis F, Bouillon B, Cavina E, et al. The European experience with vascular injuries. Surg Clin North Am. 2002;82:175–87.CrossRefGoogle Scholar
  17. 17.
    Nehler MR, Taylor LM, Porter JM. Iatrogenic vascular trauma. Semin Vasc Surg. 1998;11:283–93.PubMedGoogle Scholar
  18. 18.
    Orcutt MB, Levine BA, Gaskill HV, Sirinek KR. Iatrogenic vascular injury: a reducible problem. Arch Surg. 1985;120:384–6.CrossRefGoogle Scholar
  19. 19.
    Pedrini L, Stella A, Curti T, Paragova O, Pisano E, Sacca A. Iatrogenic vascular lesions: pathogenesis and treatment; an 18 year experience. Int Angiol. 1991;10:233–7.PubMedGoogle Scholar
  20. 20.
    Lazarides MK, Arvanitis DP, Anastasios CL, Dayantas JN. Iatrogenic and noniatrogenic arterial trauma: a comparative study. Eur J Surg. 1991;157:17–20.PubMedGoogle Scholar
  21. 21.
    Irita K, Kawashima Y, Morita K, Seo N, Iwao Y, et al. Supplemental survey in 2003 concerning life-threatening hemorrhagic events in the operating room. Masui. 2005;54:77–86.PubMedGoogle Scholar
  22. 22.
    Tayeb MM, Knoedler JJ, Krambeck AE. Vascular complications after percutaneous nephrolithotomy: ten years of experience. Urology. 2015;85:777–81.CrossRefGoogle Scholar
  23. 23.
    Brown J, Garlitz C, Gomella L, et al. Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy. Urol Oncol. 2004;22:102–6.CrossRefGoogle Scholar
  24. 24.
    Rutledge R, Hoyt DB, Eastman AB, Sise MJ, Velky T, Canty T, et al. Comparison of the injury severity score and ICD-9 diagnosis codes as predictors of outcome in injury: analysis of 44,032 patients. J Trauma. 1997;42:477–87.CrossRefGoogle Scholar
  25. 25.
    Opitz I, Gantert W, Giger U, et al. Bleeding remains a major complication during laparoscopic surgery;: analysis of the SALTS database. Langenbeck's Arch Surg. 2005;390:128–33.CrossRefGoogle Scholar
  26. 26.
    Wani ML, Ahangar AG, Ganie FA, Wani SN, Wani N. Vascular injuries: trends in management. Trauma Mon. 2012;17:266–9.CrossRefGoogle Scholar
  27. 27.
    Feliciano DV, Moore EE, Biffl WL. Western trauma association critical decisions in trauma: management of abdominal vascular trauma. J Trauma Acute Care Surg. 2015;79:1079–88.CrossRefGoogle Scholar
  28. 28.
    Germanos S, Gourgiotis S, Villias C, Bertucci M, Dimopoulos N, Salemis N. Damage control surgery in the abdomen: an approach for the management of severed injured patients. Int J Surg. 2008;6:246–52.CrossRefGoogle Scholar
  29. 29.
    Godat L, Kobayashi L, Constatini T, Coimbra R. Abdominal damage control surgery and reconstruction: world society of emergency surgery position paper. World J Emerg Med. 2013;8:53–60.CrossRefGoogle Scholar
  30. 30.
    Asensio JA, McDuffle L, Petrone P, Roldan G, Forno W, Gambaro E, et al. Reliable variables in the exsanguinated patient which indicate damage control and predict outcome. Am J Surg. 2001;182:743–51.CrossRefGoogle Scholar
  31. 31.
    Loveland JA, Boffard KD. Damage control in the abdomen and beyond. Br J Surg. 2004;91:1095–101.CrossRefGoogle Scholar
  32. 32.
    Miller RS, Morris JA Jr, Diaz JJ Jr, Herring MB, May AK. Complications after 344 damage-control open celiotomies. J Trauma. 2005;59:1365–71.CrossRefGoogle Scholar
  33. 33.
    • Gonzalez J, Gorin MA, Garcia-Roig M, Ciancio G. Inferior vena cava resection and reconstruction: technical considerations in the management of renal cell carcinoma with tumot thrombus. Urol Oncol. 2014;32:34.e19–26 Excellent review on venous resection and reconstruction.CrossRefGoogle Scholar
  34. 34.
    Demirel S, Winter C, Rapprich B, et al. Stab injury of the superior mesenteric artery with life threatening bleeding—endovascular treatment with an unusual technique. VASA. 2010;39:268–70.CrossRefGoogle Scholar
  35. 35.
    • Fildes J, Meredith JW, Hoyt DB, et al., Trauma ACoSCo. ASSET (Advanced Surgical Skills for Exposure in Trauma): exposure techniques when time matters: American College of Surgeons, 2010. Extremely useful review on emergency vascular exposure Google Scholar
  36. 36.
    •• Hoyt DB, Coimbra R, Potenza BM, et al. Anatomic exposures for vascular injuries. Surg Clin North Am. 2001;81:1299–330 A must for every surgeon dealing with vascular complications.CrossRefGoogle Scholar
  37. 37.
    Asensio JA, Petrone P, Kimbrell B, et al. Lessons learnt in the management of thirteen celiac axis injuries. South Med J. 2005;98:462–6.CrossRefGoogle Scholar
  38. 38.
    Asensio JA, Britt LD, Borzotta A, et al. Multiinstitutional experience with the management of superior mesenteric artery injuries. J Am Coll Surg. 2001;193:354–65.CrossRefGoogle Scholar
  39. 39.
    • Gonzalez J, Gaynor JJ, Alameddine M, Ciancio G. Evolution of the application of techniques derived from abdominal transplant surgery in urologic oncology. Curr Urol Rep. 2018;19:6 Comprehensive review on the different approaches and maneuvers for vascular Access and control.CrossRefGoogle Scholar
  40. 40.
    Coimbra R, Yang J, Hoyt DB. Injuries of the abdominal aorta and inferior vena cava in association with thoracolumbar fractures: a lethal combination. J Trauma. 1996;41:533–5.CrossRefGoogle Scholar
  41. 41.
    Asensio JA, Petrone P, Roldan G, et al. Analysis of 185 iliac vessel injuries: risk factors and predictors of outcome. Arch Surg. 2003;138:1187–93 discussion 1193–4.CrossRefGoogle Scholar
  42. 42.
    Carr JA, Kralovich KA, Patton JH, et al. Primary venorrhaphy for traumatic inferior vena cava injuries. Am Surg. 2001;67:207–13 discussion 13–14.PubMedGoogle Scholar
  43. 43.
    Hansen CJ, Bernadas C, West MA, et al. Abdominal vena caval injuries: outcomes remain dismal. Surgery. 2000;128:572–8.CrossRefGoogle Scholar
  44. 44.
    Schrock T, Blaisdell FW, Mathewson C Jr. Management of blunt trauma to the liver and hepatic veins. Arch Surg. 1968;96:698–704.CrossRefGoogle Scholar
  45. 45.
    Burch JM, Feliciano DV, Mattox KL. The atriocaval shunt. Facts and fiction. Ann Surg. 1988;207:555–68.CrossRefGoogle Scholar
  46. 46.
    Coimbra R, Filho AR, Nesser RA, et al. Outcome from traumatic injury of the portal and superior mesenteric veins. Vasc Endovasc Surg. 2004;38:249–55.CrossRefGoogle Scholar
  47. 47.
    Fraga GP, Bansal V, Fortlage D, et al. A 20-year experience with portal and superior mesenteric venous injuries: has anything changed? Eur J Vasc Endovasc Surg. 2009;37:87–91.CrossRefGoogle Scholar
  48. 48.
    Carroll PR, McAninch JW, Klosterman P, et al. Renovascular trauma: risk assessment, surgical management, and outcome. J Trauma. 1990;30:547–52 discussion 553–4.CrossRefGoogle Scholar
  49. 49.
    Alameddine M, Moghadamyeghaneh Z, Yusufali A, et al. Kidney autotransplantation: between the past and the future. Curr Urol Rep. 2018;19:7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Javier González
    • 1
    Email author
  • Francisco J. Angulo-Morales
    • 2
  • Enrique Lledó-García
    • 1
    • 3
  1. 1.Servicio de UrologíaHospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Servicio de Cirugía General y del Aparato Digestivo, Hospital Central de la Cruz Roja San José y Santa AdelaUniversidad Alfonso X el SabioVillanueva de la CañadaSpain
  3. 3.Departmento de CirugíaUniversidad Complutense de MadridMadridSpain

Personalised recommendations