Aortic aneurysm surgeries are done worldwide on an elective/emergent basis. The last two decades has seen immense changes in the way Vascular surgeons approach aneurysms.May be its the endovascular approach to an aneurysm or else the intraoperative approach per se,the situation has changed for the betterment of patients.Mortality rates have come down significantly,thanks to the ever changing science thats giving us varied options to make lives of patients and the operating surgeons a bit easy.Still there are questions to be addressed.
Venous injuries are not unknown during aortic surgeries more so in cases of Abdominal Aortic Aneurysms(AAA).These so called iatrogenic injuries lead to a significant intraoperative blood loss and can prove fatal.Not sure what the figures are but I am pretty convinced these injuries have a high mortality/morbidity rate which goes unreported.
We recently encountered a case of AAA which looked relatively straight forward.In the process of taking distal control individually we ended up injuring the IVC at the junction where the two iliac veins drain into it.Thereafter started the process of taking control of the venous bleed and all I can say is those 40 odd minutes gave us one hell of a time.Probably my inclination doing venous thrombectomies did bail me out and we finally emerged unhurt but learnt a good lesson ’DISASTER STRIKES YOU WHEN YOU LEAST EXPECT IT’.
Still not sure what the best approach is?Surgeons have tried different things like balloon occlusion of the iliac arteries rather than taking distal control individually or else taking control of the vessels without dissecting them cicumferentially. Balloon occlusion is not a bad approach I guess.Anyways a good lesson learnt.
As young and enthusiastic Vascular Surgeons we guys try to do things copybook.No harm in doing things as projected in the standard textbooks but somewhere down the lane experience does count and I suggest my fellow colleagues esp.the young guns to read more about COMPLICATIONS IN VASCULAR SURGERY and be upto it.
