Catastrophic Intraoperative Systemic Vascular Injuries in Elective Thoracic Surgery: A 10-Year Retrospective Single-Center Study

BACKGROUND: Systemic vascular injuries during elective thoracic surgery are rare, but potentially life-threatening complications. Their occurrence is closely related to tumor-vessel proximity and intraoperative technical challenges. AIMS: To determine the incidence proportion, mechanisms, and clinical outcomes of systemic vascular injuries during elective thoracic surgery, and to assess the impact of multidisciplinary preoperative planning. METHODS: This retrospective descriptive study reviewed patients with intraoperative systemic vascular injuries during elective thoracic surgery at a tertiary center between January 2015 and December 2024. Demographic, surgical, and perioperative data-including injured vessel, blood loss, transfusion, complications, and need for cardiovascular surgery (CVS) support-were analyzed. Pulmonary artery injuries and emergency surgeries were excluded. RESULTS: Of 7,597 elective thoracic surgeries, 11 patients (0.15%) sustained systemic vascular injuries. The most injured vessels were the superior vena cava (SVC), brachiocephalic vein, and subclavian artery. Preoperative imaging failed to detect vascular invasion in 45.5% of patients. CVS consultation was obtained in 5 cases (45.5%), but cardiopulmonary bypass (CPB) was not required. Median blood loss and transfusion requirements were higher in the CVS group, though differences were not statistically significant. Three patients (27.3%) died during the postoperative period, with pulmonary complications such as pneumonia identified as the primary cause of death. One neoadjuvant-treated patient experienced a subclavian artery injury requiring graft interposition. CONCLUSIONS: Although uncommon, systemic vascular injuries in elective thoracic surgery are associated with significant morbidity and mortality. Preoperative imaging may underestimate vascular risk. Multidisciplinary planning and intraoperative preparedness are essential to mitigate complications. Larger multicenter prospective studies are warranted to develop standardized preventive strategies.