Iatrogenic vascular injury following arterial cannulation: the importance of early surgery.

Prospective data were collected over a 7-year period on patients undergoing repair of iatrogenic vascular injury following arterial cannulation. From 9375 procedures (7790 coronary angiograms, 835 coronary angioplasties, 445 other cardiac catheterizations, 155 femoral angiograms, 150 peripheral angioplasties) surgical repair was required in 26 patients. The overall incidence of significant injury was 0.28% and higher in therapeutic than diagnostic procedures. The mode of presentation included: critical limb ischaemia in 18 cases, false aneurysm in three, haematoma in three and claudication in two. The common femoral artery was the most common site of injury. No patient presenting with false aneurysm or haematoma suffered any deleterious sequelae. However, 50% of those presenting with critical ischaemia suffered permanent disability after operation. The median delay to surgery was significantly longer in this group (24 versus 4 h; P < 0.001) but there was no difference in age or incidence of underlying peripheral vascular disease. The physical, psychological and litigious sequelae of the complications of iatrogenic vascular injury cannot be overstated. It is strongly advocated that immediate surgical consultation be applied when limb ischaemia is suspected.