Principles and Surgical Techniques in the Management of Intraoperative Retroperitoneal Vascular Injury

Objective: To assess the surgical techniques and ideas in the treatment of the intraoperative retroperitoneal vascular injury. Methods: Between Oct 2017 and Dec 2019, 85 retroperitoneal tumor patients with retroperitoneal vascular injury intraoperatively in Changhai Hospital, Naval Medical University were analyzed retrospectively. Among them, the arterial injury occurred in 52 patients, the venous injury occurred in 49 patients, and 16 patients had both arterial and venous injuries. Main disease diagnosis, common types of vascular injury, different management methods, and results of vascular injury were analyzed. Results: The most common type of diagnosis is a retroperitoneal primary malignant tumor, followed by metastatic malignant tumor and retroperitoneal benign tumor. The most frequent injury arteries were the aorta (12 patients) and common iliac artery (12 patients), followed by the external iliac artery (6 patients) and superior mesenteric artery (6 patients). The most frequent injury vein was inferior vena cava (10 patients), followed by internal iliac vein (7 patients), external iliac vein (6 patients), inferior mesenteric vein (6 patients), and common iliac vein (4 patients). A total of 19 patients received artificial vessels replacements, including aortic replacement (4 patients), renal artery replacement (1 patient), superior mesenteric artery (2 patients), common iliac artery (5 patients), external iliac artery (3 patients), inferior vena cava (1 patient), Right renal vein (1 patient), common iliac vein (1 patient) and external iliac vein (1 patient). The remaining patients underwent ligation and sutures to achieve hemostasis. All patients attained hemostasis in the operating room and were admitted to medical wards or the medical ICU. After artificial vessels replacements, one patient died of DIC postoperatively, other patients had an uneventful perioperative course, no anastomotic bleeding was reported. Conclusion: In the management of intraoperative retroperitoneal vascular injury, it is important to assess the extent of injury, select reasonable remediation methods, and adopt artificial vessels replacements when necessary.