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Ruffilli A, Barile F, Fiore M, Pasini S, Facchini G, Faldini C. Occurrence of L4 Lumbar Artery Pseudoaneurysm After Posterior Reduction and L4-L5 Fusion for Grade I Anterolisthesis: A Case Report. JBJS Case Connect 2020; 10:e20.00117. [PMID: 33449551 DOI: 10.2106/jbjs.cc.20.00117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe the case of a 53-year-old man who developed acute groin pain 20 days after a posterior L4-L5 interbody fusion. Despite positioning of pedicle screws within the safe zone, an L4 right lumbar artery pseudoaneurysm was found on computer tomography angiogram. Coil embolization was successfully performed. CONCLUSION Iatrogenic lumbar artery pseudoaneurysms are a rare complication of spinal surgery. Our case is, to the best of our knowledge, the only reported case where this lesion occurred despite good positioning of the screws: It is therefore important to always suspect and exclude this complication in case of suggestive symptoms.
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Kuo AH, Cho CH, Huang RY, Kim CJ, Lee TC. Target-specific yield rate and clinical utility of percutaneous tissue sampling in spinal infection. Clin Imaging 2020; 68:257-262. [DOI: 10.1016/j.clinimag.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
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Latka K, Zurawel R, Maj B, Olbrycht T, Chowaniec J, Latka D. Iatrogenic lumbar artery pseudoaneurysm after lumbar transpedicular fixation: Case report. SAGE Open Med Case Rep 2019; 7:2050313X19835344. [PMID: 30858976 PMCID: PMC6404053 DOI: 10.1177/2050313x19835344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/12/2019] [Indexed: 12/03/2022] Open
Abstract
Only a few cases of iatrogenic lumbar injury have been reported in the
literature. A 58-year-old male with severe back pain was admitted to our
department. The patient was qualified for the transpedicular stabilization with
interbody fixation at L4/L5 and L5/S1 levels. On the first day after surgery,
the patient was mobile and reported significant pain relief. He was discharged
the same day. After 2 weeks, the patient returned with severe right lower
abdominal pain and radicular pain in his right leg. He was administered to the
Neurology Department where the presence of a lumbar muscle hematoma and lumbar
artery pseudoaneurysm were discovered. He was transferred to the Vascular
Surgery Department where aortography was performed and the pseudoaneurysm was
embolized. After few days, the patient’s overall condition improved
significantly. Eight weeks after surgery, he was pain-free. Our case shows how
initially innocuous symptoms may be the result of serious complications.
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Affiliation(s)
- Kajetan Latka
- Department of Neurosurgery, Opole University Hospital, Opole, Poland
| | - Robert Zurawel
- Department of General and Vascular Surgery, Opole University Hospital, Opole, Poland
| | - Boguslaw Maj
- Department of Neurosurgery, Opole University Hospital, Opole, Poland
| | - Tomasz Olbrycht
- Department of Neurosurgery, Opole University Hospital, Opole, Poland
| | - Jacek Chowaniec
- Department of Neurosurgery, Opole University Hospital, Opole, Poland
| | - Dariusz Latka
- Department of Neurosurgery, Opole University Hospital, Opole, Poland
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Iatrogenic Lumbar Artery Injury in Spine Surgery: A Literature Review. World Neurosurg 2019; 122:266-271. [DOI: 10.1016/j.wneu.2018.10.219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
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Nandy K, Patel M, Deshpande A. A Rare Case of Spontaneous Massive Retroperitoneal Hemorrhage Due to Idiopathic lumbar Artery Bleed. J Emerg Trauma Shock 2018; 11:238-239. [PMID: 30429636 PMCID: PMC6182973 DOI: 10.4103/jets.jets_56_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kunal Nandy
- Department of General Surgery, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Maitreyi Patel
- Department of General Surgery, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Aparna Deshpande
- Department of General Surgery, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India. E-mail:
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Endovascular management of posttraumatic and iatrogenic large pelvic pseudoaneurysms following biopsy: case report. Radiol Case Rep 2016; 12:102-107. [PMID: 28228890 PMCID: PMC5310381 DOI: 10.1016/j.radcr.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 10/30/2016] [Accepted: 11/23/2016] [Indexed: 11/24/2022] Open
Abstract
Pelvic traumatic and iatrogenic pseudoaneurysms supplied by the internal iliac artery are very rare but can present with pain, nerve compression, and rupture. Particularly with more chronic pseudoaneurysms, their imaging appearance can be confusing and they can be mistaken for tumors. We present two cases of pelvic pseudoaneurysms supplied by the superior gluteal artery that were initially mistaken for masses and subsequently biopsied. We report the subsequent successful endovascular embolization technique subsequently utilized for both of these cases. A high index of suspicion should be maintained to avoid biopsy of these lesions. In the appropriately selected patient, an endovascular approach may be safely used to perform embolization.
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Ikeda O, Kawanaka K, Nakasone Y, Tamura Y, Yamashita Y. Direct percutaneous embolization of an iatrogenic lumbar artery pseudoaneurysm following unsuccessful coil embolization. Acta Radiol 2012; 53:541-4. [PMID: 22527537 DOI: 10.1258/ar.2012.110210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A 56-year-old man with acute myeloleukemia was hospitalized for lumbar pain. Treatment with antibiotics failed to improve the symptoms. For the diagnosis of infiltration by leukemia we performed CT-guided percutaneous needle biopsy of the L2-L3 disc and the L3 vertebral body using a left posterolateral approach. His symptoms were improved by treatment with antibiotics and he was discharged 4 days later. He again experienced lumbar pain 4 days post-discharge and was readmitted. Unenhanced CT scans of the abdomen and pelvis revealed a giant hematoma in the left psoas muscle and we suspected lumbar arterial injury. A preoperative aortography and transcatheter arterial coil embolization was then performed for the diagnosis and treatment of a lumbar artery pseudoaneurysm. On the preoperative angiography, pseudoaneurysm arising from the left lumbar artery was shown. All feeders were shown by the selective catheterization of the lumbar arteries and they were completely embolized using coils. However, contrast-enhanced CT obtained on the next day still demonstrated a pseudoaneurysm in the left psoas muscle. Thus, additional percutaneous embolization using N-butyl-2-cyanoacrylate was performed. After this procedure, complete embolization of the pseudoaneurysm was obtained and his lumbar pain was relieved.
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Affiliation(s)
- Osamu Ikeda
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Koichi Kawanaka
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Yutaka Nakasone
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Yoshitaka Tamura
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
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Sandri A, Regis D, Marino MA, Puppini G, Bartolozzi P. Lumbar artery injury following posterior spinal instrumentation for scoliosis. Orthopedics 2011; 34. [PMID: 21469623 DOI: 10.3928/01477447-20110228-24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Vascular injuries are uncommon but potentially serious complications of spinal surgery. Lumbar artery lesion complicating posterior spinal instrumentation for scoliosis has been occasionally described. A 39-year-old woman with adult scoliosis was treated with correction and stabilization from T8 to L5 via a midline posterior approach. Transpedicular screws were inserted from levels L1 to L5 on the convex left side and at T11, T12, L4, and L5 on the concavity right side. Pedicle screws were not inserted from L2 to L4 on the right side due to difficulty identifying the pedicle channel with the probe. The instrumentation was completed with 2 hooks at T8 and T5 on the left side and 1 at T7. Five hours postoperatively, the patient suffered a hypotensive attack and her abdomen was distended. Her hemoglobin level was 4.5 g/dL. Hemodynamic stabilization was achieved with emergent therapy, including fluid resuscitation, blood, and plasma transfusion. An urgent contrast-enhanced abdominal computed tomography scan showed a large hematoma at the right retroperitoneum with active extravasation of contrast medium, but the source of bleeding was not detectable because of metallic artifacts. Immediate angiography demonstrated rupture of the third right lumbar artery. Selective microcoil embolization was performed with occlusion of the corresponding branch. The bleeding stopped and hemodynamic parameters were stable. No spinal cord impairment or muscle infarction occurred, and 1-year follow-up was uneventful. Lumbar artery injury should be considered as a complication after posterior spinal surgery for scoliosis and prompt diagnosis and intervention are required. Selective lumbar artery embolization is a safe and effective procedure to stop bleeding in hemodynamically stable patients after fluid resuscitation and blood transfusion.
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Affiliation(s)
- Andrea Sandri
- Department of Orthopedic Surgery, Azienda Ospedaliera Universiteria Integrata, Policlinico GB Rossi, Italy.
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Nasser F, Affonso BB, Zurstrassen CE, Sousa Junior WDO, Leal Filho JMDM, Yamada F, Petterle PH, Carnevale FC. Sangramento espontâneo de artéria lombar em paciente com doença de Von Recklinghausen: tratamento endovascular. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000400016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Os sangramentos no retroperitônio são, em sua grande maioria, secundários a eventos traumáticos envolvendo grande energia cinética, com poucos relatos na literatura caracterizados como espontâneos. No presente relato, descrevemos paciente gestante, portadora de doença de Von Recklinghausen e com volumoso hematoma retroperitoneal diagnosticado durante o parto cesariano, secundário a ruptura espontânea de artéria lombar. A doença de Von Recklinghausen apresenta manifestações vasculares bem descritas, caracterizando-se principalmente por estenoses que são secundárias a tumores intramurais (proliferação das células de Schwann) e raramente dilatações aneurismáticas, assintomáticas em sua maioria. No presente caso, foi realizada a aortografia com cateterização seletiva e embolização da artéria sangrante com sucesso.
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Dausse F, Chevallier P, Motamedi JP, Amoretti N, Cua E, Bruneton JN. Lumbar false aneurysms following image-guided interventive procedures for spondylodiskitic abscesses. Skeletal Radiol 2006; 35:949-52. [PMID: 16528549 DOI: 10.1007/s00256-005-0064-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 08/08/2005] [Accepted: 10/25/2005] [Indexed: 02/02/2023]
Abstract
Pseudoaneurysms of the lumbar arteries are infrequent, and are most often found incidentally after trauma to the lumbar spine. More rarely, they are an iatrogenic complication from diagnostic or therapeutic procedures, particularly of the kidney. Their rupture can cause rapid clinical deterioration by retroperitoneal hemorrhage, and therefore their diagnosis and treatment must be rapid. We report two cases of lumbar artery false aneurysms arising as a complication during the treatment of infectious disciitis. The diagnoses were established via CT and immediately followed by expeditious treatment by selective arterial embolization.
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Shigematsu Y, Kudoh K, Nakasone Y, Fujisaki T, Uemura S, Yamashita Y. Nontraumatic Rupture of Lumbar Artery Causing an Intravertebral Body Pseudoaneurysm: Treatment by Transcatheter Embolization. Cardiovasc Intervent Radiol 2006; 29:870-4. [PMID: 16718425 DOI: 10.1007/s00270-004-7187-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case of nontraumatic rupture of the lumbar artery that led to a pseudoaneurysm in the vertebral body and massive retroperitoneal to retropleural hematoma. The pseudoaneurysm was successfully treated by endovascular embolization. To our knowledge, idiopathic rupture of the lumbar artery has been reported in a limited number of cases and pseudoaneurysm formation in the vertebral body has not been presented in the literature. The etiology of hemorrhage has been discussed based on CT, MRI, and three-dimensional rotational angiography.
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Affiliation(s)
- Yoshinori Shigematsu
- Department of Radiology, Internal Medicine, and Neurosurgery, Amakusa Medical Center, 854-1 Kameba, Hondo, Kumamato 863-0046, Japan.
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Jain R, Kumar S, Phadke RV, Baijal SS, Gujral RB. Intra-arterial embolization of lumbar artery pseudoaneurysm following percutaneous nephrolithotomy. AUSTRALASIAN RADIOLOGY 2001; 45:383-6. [PMID: 11531772 DOI: 10.1046/j.1440-1673.2001.00880.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The management of a patient with haematuria following percutaneous nephrolithotomy is described. The patient underwent renal angiography to assess the cause of bleeding. A pseudoaneurysm arising from first left lumbar artery was incidentally discovered, which was then successfully embolized using an indigenously fabricated metallic coil and gel foam particles in the same sitting.
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Affiliation(s)
- R Jain
- Department of Radiodiagnosis, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Rae Bareily Road, Lucknow, Uttar Pradesh 226014, India
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