Vascular Injury During Urologic Surgery: Somebody Call My Mother
- 26 Downloads
Purpose of Review
To provide the critical elements to effectively manage hemorrhage from vascular injuries sustained during planned urological interventions.
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.
KeywordsUrologic 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
- 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
- 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.Esmarch F. The surgeon’s handbook of the treatment of the wounded in war. New York: LW Schmidt; 1878.Google Scholar
- 6.Jassinowsky A. Die arteriennhat: eine experimentelle studie. Inaug Diss Dorpat. 1889.Google Scholar
- 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.Carrel A, Guthrie CC. Uniterminal and biterminal venous transplantations. Surg Gynecol Obstet. 1906;2:266–86.Google Scholar
- 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
- 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