Iatrogenic and non-iatrogenic vascular trauma in a district general hospital: a 21-year review.

BACKGROUND: Vascular trauma is associated with significant mortality and severe complications. Vascular injuries in the UK are infrequent, although the exact incidence remains unknown. The objective of this article is to describe patients presenting with vascular trauma to one surgeon over 21 years in a British hospital.
METHODS: A retrospective review of prospectively collected data was performed and supplemented by case notes retrieval. Patients' details, including cause and nature of vascular injury, intervention, and long-term survival, were recorded. Statistical analysis was performed by comparison of survival curves using a log-rank test.
RESULTS: Eighty-nine patients presented, including 44 men (49%). Iatrogenic trauma accounted for 63 cases (71%) with a median age of 63 years (range = 33-91), and 51 of these cases (81%) occurred either following peripheral angioplasty (n = 40) or after cardiac catheterisation (n = 11). Within the non-iatrogenic group (n = 26), median age was 35 years (range = 15-71), with 19 cases (58%) situated in the lower limb. There were no amputations. Median survival of patients following peripheral vascular intervention was 83 months, compared with 180 months following coronary procedures. No patient died following non-iatrogenic trauma.
CONCLUSION: Vascular trauma remains a serious although uncommon phenomenon, with a trend in the UK of increasing iatrogenic trauma. To ensure the best possible outcomes, future rotas and designation of services will need to guarantee the consistent availability of a vascular surgeon. A British national registry on vascular trauma is currently lacking and would assist in identifying national trends and comparing international outcomes and epidemiology.