Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Management of Proximal Iliac Artery Injury during Lumbar Discectomy with Stent Graft

  • Jin, Sung-Cheol (Department of Neurosurgery, College of Medicine, Inje University) ;
  • Park, Sang-Woo (Department of Radiology, College of Medicine, Konkuk University) ;
  • Cho, Do-Sang (Department of Neurosurgery, School of Medicine, Ewha Womans University)
  • Received : 2010.09.24
  • Accepted : 2012.04.17
  • Published : 2012.04.28
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Abstract

Iatrogenic vascular injuries during lumbar disc surgery may occur rarely but they are serious complications, which can be fatal without appropriate management Prompt diagnosis and management of these complications are imperative to prevent a desperate outcome. A 72-year-Old female with proximal left common iliac artery iatrogenic injury during lumbar discectomy was successfully treated by percutaneous deployment of a stent graft in an emergency setting. Postprocedural angiogram demonstrated complete exclusion of the iliac artery laceration. The patient became hemodynamically stable. Two weeks later she complained of vascular claudication. Follow-up angiography revealed decreased arterial flow in the opposite common iliac artery. An additional kissing stent was inserted into the right common iliac artery and the symptoms of vascular claudication disappeared. Endovascular stenting offers a safe and effective method for the treatment of an iatrogenic arterial laceration, particularly in a critical condition. But, the contralateral iliac arterial flow should be kept intact in case of proximal iliac artery injury. Otherwise, additional treatments may be needed.

Keywords

References

  1. Bierdrager E, Van Rooij WJ, Sluzewski M : Emergency stenting to control massive bleeding of injured iliac artery following lumbar disk surgery. Neuroradiology 46 : 404-406, 2004 https://doi.org/10.1007/s00234-004-1198-y
  2. Erkut B, Unlu Y, Kaygin MA, Colak A, Erdem AF : Iatrogenic vascular injury during to lumbar disc surgery. Acta Neurochir (Wien) 149 : 511-515; discussion 516, 2007 https://doi.org/10.1007/s00701-007-1132-2
  3. Ewah B, Calder I : Intraoperative death during lumbar discectomy. Br J Anaesth 66 : 721-723, 1991 https://doi.org/10.1093/bja/66.6.721
  4. McCarter DH, Johnstone RD, McInnes GC, Reid DB, Pollock JG, Reid AW : Iliac arteriovenous fistula following lumbar disc surgery treated by percutaneous endoluminal stent grafting. Br J Surg 83 : 796-797, 1996 https://doi.org/10.1002/bjs.1800830622
  5. Nam TK, Park SW, Shim HJ, Hwang SN : Endovascular treatment for common iliac artery injury complicating lumbar disc surgery : limited usefulness of temporary balloon occlusion. J Korean Neurosurg Soc 46 : 261-264, 2009 https://doi.org/10.3340/jkns.2009.46.3.261
  6. Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA : Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg 24 : 189-195, 2002 https://doi.org/10.1053/ejvs.2002.1682
  7. Rees CR, Palmaz JC, Garcia O, Roeren T, Richter GM, Gardiner G Jr, et al. : Angioplasty and stenting of completely occluded iliac arteries. Radiology 172 : 953-959, 1989 https://doi.org/10.1148/172.3.953
  8. Salander JM, Youkey JR, Rich NM, Olson DW, Clagett GP : Vascular injury related to lumbar disk surgery. J Trauma 24 : 628-631, 1984 https://doi.org/10.1097/00005373-198407000-00015
  9. Sande E, Myhre HO, Witsoe E, Lundbom J, Stolt-Nielsen A, Anda S : Vascular complications of lumbar disc surgery. Case report. Eur J Surg 157 : 141-143, 1991
  10. Smith JC, Watkins GE, Taylor FC, Carlson LA, Karst JG, Smith DC : Angioplasty or stent placement in the proximal common iliac artery : is protection of the contralateral side necessary? J Vasc Interv Radiol 12 : 1395-1398, 2001 https://doi.org/10.1016/S1051-0443(07)61696-0
  11. Spinosa DJ, Angle JF, Hagspiel KD, Pyle DA, Matsumoto AH : Iliac artery stenting : a review of devices and technical considerations. Appl Radiol 27 : 10-24, 1998
  12. Szolar DH, Preidler KW, Steiner H, Riepl T, Flaschka G, Stiskal M, et al. : Vascular complications in lumbar disk surgery : report of four cases. Neuroradiology 38 : 521-525, 1996 https://doi.org/10.1007/BF00626086
  13. Vorwerk D, Gunther RW, Keulers P, Wendt G : Surgical and percutaneous management of contralateral thrombus dislodgement following stent placement and dilatation of iliac artery occlusions : technical note. Cardiovasc Intervent Radiol 14 : 134-136, 1991 https://doi.org/10.1007/BF02577714

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