Iatrogenic vascular injuries (ⅣJ) are vascular injuries that occur during the diagnosis and treatment of disease. With the popularization of vascular surgery knowledge and improvement of technology, serious large vessel injuries due to surgical errors and unclear anatomy have been greatly reduced. However, the incidence of medical vascular injury due to various invasive vascular operations and interventional procedures does increase year by year, while vascular injury caused by abdominal surgery is also not uncommon. The incidence of vascular injury of medical origin is not available in China, Rudstr & Ouml;m H, etc. statistics of 1853 cases of vascular injury occurred in Sweden from 1987 to 2005 found that: 48% are vascular injuries of medical origin, and increasing year by year (41-51%), the mortality rate of 4.9%, the most common injury sites in order: the right inguinal region (43%), the left inguinal region (19%), abdomen (13%), and limbs (8%) [1]. Medically induced vascular injury can be divided into four categories according to the cause of injury: 1) vascular injury due to surgery; 2) vascular injury due to endovenous therapy; 3) vascular injury due to radiation therapy; and 4) vascular injury due to drug injection therapy [2]. The main vascular injury modalities are: vascular rupture or occlusion, pseudoaneurysm, arteriovenous fistula, arterial entrapment and intravascular foreign body. For intraoperative ruptured vascular injury, the bleeding volume is often large, but it is important not to clamp blindly to stop the bleeding, which may lead to further expansion of the injury. The bleeding point can be quickly controlled by using a non-invasive vascular blocking forceps, and small breaks can be directly sutured with prolene thread. If it is difficult to separate the proximal and distal ends of the injured vessel, or if there is a lack of vascular surgery-related instruments for various reasons, a balloon or foley’s balloon ureter can be placed through the rupture to block the blood flow. In a patient with extensive laceration of the upper and lower renal vena cava, the author used a Foley’s ureter to block the proximal segment of the inferior vena cava and then isolated the inferior vena cava to the posterior hepatic segment, which was successfully repaired. For intraoperative failure to detect surgically induced vascular rupture in time, a reasonable treatment plan was formulated based on the corresponding clinical manifestations and some necessary special tests after surgery, which led to the understanding of the lesion site, the nature of the vascular injury, and the inflow and outflow of vessels near and far from the lesion, including repair of the injury site, arterial embolization, and implantation of overlapping stents [3]. Surgically induced vascular occlusion, if it is due to suture ligation, the sutures can be quickly cut and the need for reconstruction can be decided depending on the usual condition of the vessel. For patients with large segmental loss of blood vessels, reconstruction can be performed quickly with autologous or artificial vessels. The author once met a patient who underwent saphenous vein aspiration in a foreign hospital resulting in complete loss of the entire femoral artery, and was transferred to our hospital. For arterial occlusion due to arterial thrombosis, it can be solved promptly by removing the embolus or placing a thrombolytic catheter. For stenosis or occlusion caused by vascular anastomosis, timely reanastomosis can be performed according to the situation, and balloon dilation can be tried if necessary. 2. Management of pseudoaneurysms Pulsatile masses in the surgical area often suggest the formation of pseudoaneurysms. Color Doppler ultrasonography often provides a definitive diagnosis, but further angiography (including CTA, MRA and DSA) often provides more accurate anatomic information. The main treatment modalities are: 1. Compression therapy: For smaller pseudoaneurysms (less than 1.5 cm) caused by very small arterial ruptures or pseudoaneurysms with narrow necks, some of them can heal spontaneously. Treatment can be done by straightening and braking the affected limb, applying pressure bandage, applying pressure bandage after manual compression or using various compression apparatus, which can often be treated successfully. However, this method is not recommended for larger pseudoaneurysms. 2. Ultrasound-guided compression therapy and injectable thrombin embolization therapy: Fellmeth first proposed ultrasound-guided compression therapy in 1991, and since then this method has gradually become the first choice for treating pseudoaneurysms, but this method has the following drawbacks: long treatment duration; prolonged compression causing limb discomfort; low success rate of about 75%. The success rate is lower than that of anticoagulated patients, and even lower in patients treated with anticoagulation. For this reason, since 1997, many investigators have started to use ultrasound-guided thrombin embolization for pseudoaneurysms. Studies have shown that embolization therapy has a success rate of 94-100%, with a complication rate of approximately 2%. This method involves puncturing the pseudoaneurysm under ultrasound guidance and injecting thrombin into the pseudoaneurysm cavity through the puncture needle after pressing the proximal artery to reduce blood flow; if ultrasound shows thrombus formation in the aneurysm cavity, the procedure is successful; if not, the dose of thrombin injection can be increased again up to a maximum of 500 u. This method is simple, less painful, and has low complications, and can be the treatment of choice [4].3. Surgical treatment. For larger aneurysms, if the aforementioned treatment methods cannot close the aneurysm or if the patient has symptoms of ruptured bleeding, nerve, vein and surrounding tissue compression, wound infection or distal limb ischemia, surgical treatment should be considered: removal of pseudoaneurysm and revascularization.4. Endoluminal repair with overlapping stent: In recent years, with the continuous development of endoluminal technology, overlapping stent repair of pseudoaneurysm has been increasingly used by clinical workers. This method is less traumatic, less painful, and can be used by more and more clinical workers. This method is less traumatic, less painful, faster recovery and lower complications. The hematoma can be removed simultaneously after endoluminal repair. With the further improvement of the peripheral arterial stenting process, the success rate of endoluminal techniques for the treatment of medically induced pseudoaneurysms and arteriovenous fistulas will also increase. The management of arteriovenous fistulae is usually associated with surgical error, angiography, or intravenous catheter placement. While ultrasound, CTA and MRA can diagnose AVF, angiography is the gold standard for diagnosing AVF, as it can identify the site of the fistula and the error rate of an experienced physician should be less than 3%. However, it should be noted that traumatic AVF is often not detected by angiography in the early stages of injury and is only diagnosed on follow-up angiography due to vasospasm and hematoma compression in the early stages of injury. Surgical treatment is feasible for arteriovenous fistulas with early definite rupture, and local vascular dissection and resection of the fistula to reconstruct the artery is effective. However, for longer arteriovenous fistulas, surgical separation is often very difficult due to long-term venous hypertension, significant local venous dilatation, thinning of the vessel wall, and rapid blood flow, which not only makes bleeding difficult to control but also easily damages surrounding tissues and organs. Endoluminal treatment is very advantageous in dealing with this problem and there are two main methods: embolization therapy and overlapping stents. The key to successful treatment is the closure of all arteries supplying the fistula, including all branches and collateral vessels entering the fistula in the proximal and distal segments of the injured artery. Therefore, only accurate and complete angiography can ensure successful embolization. The introduction of overlapping stents in recent years has expanded the indications for transvascular therapy, and their use in the treatment of AVF in relatively large vessels is effective, with durable closure of AVF [5] [6]. 4. Management of arterial entrapment and intravascular foreign bodies Arterial entrapment is mostly caused by endothelial tears caused by guidewires entering the entrapment balloon dilatation molding through the occluded segment of the vessel and by the applied balloon in the aortic lumen. The formation of the layer is characterized by a weakened or absent distal arterial pulsation and local ischemia. For intraoperative arterial entrapment caused by balloon dilatation, the rupture is rapidly detected by imaging and repaired by applying a bare stent to the endothelium or by applying a laminated stent. If postoperative arterial entrapment occurs, its management depends on the degree of ischemia caused by the entrapment. If aortic entrapment is suspected, it is best to perform an urgent aortogram to understand the tear, the extent of the entrapment, and the inflow and outflow tracts. The surgical approach depends on the site and extent of the entrapment, with bypass surgery for long and short segments and endarterectomy, patching and balloon-expandable stenting for short segments. For aortic entrapment with large lacerations and progression and extent of entrapment, luminal repair with overlapping stents may be performed. Intravascular foreign bodies are most often seen as a result of errors during interventional procedures, as well as problems with device design. Most of them are found in the following cases: catheter and guidewire are broken or fractured in the vessel; intravascular implant and guidewire are dislodged in the vessel, etc. To prevent intravascular foreign bodies, the following points should be noted: avoid reuse of interventional consumables, avoid rough handling, accurate measurement of intravascular diameter before implant placement, and standardization of interventional procedures. In case of intravascular foreign body, the foreign body should be promptly removed by grasper or surgical incision. It is important not to conceal the foreign body by fluke, which may lead to embolism, secondary thrombosis and penetration of the vessel or heart wall, and then cause serious organ function damage or even endanger life. In conclusion, although there are many causes of medically induced vascular injury, it is mainly due to irregular and meticulous operation and dissection, and it is important to strengthen responsibility and careful preoperative preparation and surgical design and selection of instruments to minimize the incidence. Once medical vascular injury occurs, it should be detected as early as possible, diagnosed as soon as possible, and treated in a timely and correct manner to reduce the patient’s pain and improve the prognosis.