vascular_injury_during_lumbar_spine_surgery

Vascular injury during lumbar spine surgery is a relatively rare complication but can have devastating outcomes. The injury may not be apparent during surgery and can present acutely or late in various manners, and some injuries can be asymptomatic.

2013

In 3 patients presenting with massive hematuria after urinary diversion, an iliac artery pseudoaneurysm was found on imaging studies. These pseudoaneurysms were considered to be associated with a fistula between artery and pouch, causing the hematuria. All patients were successfully treated with a covered stent to exclude the pseudoaneurysm and the arteriovesical fistula. Clinical follow-up of 10 weeks, 16 months, and 27 months, respectively, showed no residual hematuria. In addition, no clinical signs of stent graft infection or thrombosis were identified during follow-up. In conclusion, the placement of a covered stent is a valuable therapeutic treatment option in the management of hematuria due to an arteriovesical fistula after urinary diversion surgery 1)

2011

Seven patients were treated with acute (n = 3) or subacute (n = 4) injuries of the common iliac artery (n = 6) or abdominal aorta (n = 1) after lumbar-spine surgery. Vascular injuries included arterial lacerations (n = 3), arteriovenous fistulas (n = 2) and pseudo-aneurysms (n = 2). The mean age of the patients was 51.7 years (30-60 years), 71.4% were women. These lesions were repaired by transluminal placement of stent grafts: Passager (n = 3), Viabahn (n = 1), Wallgraft (n = 1), Zénith (n = 1) and Advanta V12 (n = 1). Exclusion of the injury was achieved in all cases. Mortality was nil. There were no procedure-related complications. During a median follow-up of 8.7 years (range 0.3-13 years), all stent grafts remained patent.

Sealing of common iliac artery or abdominal aortic lesions as a complication of lumbar-disc surgery with a stent graft is effective and is suggested as an excellent alternative to open surgery for iatrogenic great-vessel injuries, particularly in critical conditions 2).

2016

A 35-year-old woman who underwent a right L4-5 microdiscectomy for disc herniation and 4 days postoperatively presented with a pulmonary embolus. A subsequent CT scan revealed a pseudoaneurysm and arteriovenous fistula of the right common iliac vein and artery, which gave rise to the embolus. The patient received a right iliac artery stent, and at 4 months after surgery she continues to be symptom free. This report describes the atypical presentation of vascular injury after lumbar microdiscectomy and stresses the importance of cautiously using the pituitary rongeur when removing deeper disc fragments 3).

2012

A 54-year-old man who presented with pain and numbness in right hip and leg. Examination was normal. A plain radiograph showed destruction of the fourth and fifth lumbar vertebras. Magnetic resonance image showed a retroperitoneal mass eroding into the adjacent vertebras. The mass was primarily misdiagnosed as a neoplasm and a percutaneous needle biopsy was recommended. Before puncture, the computed tomographic angiogram confirmed it to be a pseudoaneurysm of left common iliac artery. Then, implantation of a covered stent was undergone.

After implantation of a covered stent, the symptoms were relieved immediately. At the 12-month follow-up, the patient remained asymptomatic, and a computed tomographic angiogram revealed progressive shrinkage of the mass and significant healing of the eroded vertebras.

As an unusual complication of lumbar disc surgery, iliac pseudoaneurysm can present with radiating pain even after 13 years and erode into the adjacent vertebras producing appearances mimicking a tumor. For mass located anterior to vertebras, the percutaneous biopsy must be cautiously performed, and a contrast-enhanced computed tomographic scan is necessary 4).


1)
Haegeman S, Vaninbroukx J, Heye S, Joniau S, Van Poppel H, Oyen R, Maleux G. Pseudoaneurysm associated with an arteriovesical fistula after bladder substitution surgery definitively treated with a covered stent: a report of 3 cases. Vasc Endovascular Surg. 2013 Nov;47(8):652-5. doi: 10.1177/1538574413500724. Epub 2013 Aug 22. PubMed PMID: 23970780.
2)
Canaud L, Hireche K, Joyeux F, D'Annoville T, Berthet JP, Marty-Ané C, Alric P. Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery. Eur J Vasc Endovasc Surg. 2011 Aug;42(2):167-71. doi: 10.1016/j.ejvs.2011.04.011. Epub 2011 May 17. PubMed PMID: 21592826.
3)
Huttman D, Cyriac M, Yu W, O'Brien JR. The unusual presentation of a vascular injury after lumbar microdiscectomy: case report. J Neurosurg Spine. 2016 Mar;24(3):381-4. doi: 10.3171/2015.7.SPINE14256. Epub 2015 Dec 4. PubMed PMID: 26637063.
4)
Luan JY, Li X. A misdiagnosed iliac pseudoaneurysm complicated lumbar disc surgery performed 13 years ago. Spine (Phila Pa 1976). 2012 Dec 1;37(25):E1594-7. doi: 10.1097/BRS.0b013e318272fd3d. PubMed PMID: 22972513.
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