Management strategies for iatrogenic urogenital vascular injuries: surgical and endovascular interventions

This study aimed to evaluate the clinical characteristics, types of vascular injury, management strategies, and short-term outcomes of iatrogenic urogenital arterial and venous injuries requiring urgent surgical or endovascular intervention. This retrospective observational study included patients who developed iatrogenic vascular injury during urogenital procedures performed between January 2020 and September 2024; although emergency procedures occurred during this period, none met the inclusion criteria. Demographic variables, comorbidities, index surgical procedures, mechanism and type of vascular injury, hemodynamic status, and details of surgical or endovascular management were extracted from institutional records. Operative notes and interventional radiology reports were reviewed to determine the injured vessel and repair technique. Postoperative outcomes—including complications, intensive care requirement, transfusion needs, reintervention, and 30-day mortality—were analyzed to assess management effectiveness. A total of 62 patients were evaluated. The population consisted mainly of older adults with significant cardiovascular comorbidities. Urologic and gynecologic malignancies were the most common underlying conditions, and extensive oncologic surgeries predominated among index procedures. Pelvic venous structures, particularly the internal iliac vein and its branches, were the most frequently injured vessels. Active extravasation represented the dominant injury pattern, and most patients required surgical rather than endovascular management. Technical success was achieved in 91.9% of patients, procedural complications occurred in 27.4%, and the 30-day mortality rate was 1.6%. Intensive care requirement and acute kidney injury occurred in a subset of high-risk patients. Iatrogenic urogenital vascular injuries remain uncommon but clinically significant events that require prompt recognition and coordinated multidisciplinary intervention. Despite the severity of these injuries, favorable procedural outcomes can be achieved with timely and appropriate management. Larger multicenter studies are needed to refine risk stratification and optimize treatment strategies.