Endovascular repair of iliac artery injury complicating lumbar disc surgery

Anterior pushing technique for a broken scalpel blade in lumbar discectomy: a case report

The presence of broken surgical blades or other surgically uncontrolled sharp and pointed objects in the disc space is a rare but potentially severe complication of posterior lumbar spine procedures. Herein, we report the case of a 59-year-old female patient with a history of lumbar decompression and interspinous process device implantation who underwent an instrumented revision of the lumbosacral junction. During the L5-S1 discectomy, the scalpel blade broke, and the broken fragment could not be retrieved through the posterior approach. With regard to the vascular anatomy, we partially pushed the fragment through the anterior annulus into the retroperitoneal space. In addition, pedicle screws were locked to ensure the stability of the construct. The fractured blade fragment was eventually removed by laparoscopy 1 week after the initial procedure. This experience suggests that the anterior pushing technique with fluoroscopy is an option in rare cases where a broken scalpel blade cannot be reached through the posterior approach. In such cases, computed tomography angiography is recommended.

Acute abdominal aortic injury during posterior lumbar fusion surgery: A case report

INTRODUCTION

Vascular injury is a serious complication during lumbar fusion surgery, leading to massive blood loss and life-threatening circulatory failure. In this study, we report on a patient with abdominal aorta injury at L2-L3 level during lumbar fusion surgery via posterior approach. Fortunately, our patient was successfully managed with prompt intervention.

PATIENT CONCERNS

A 73-year-old female was admitted to our department of low back and bilateral leg pain with claudication for over 6 months.

DIAGNOSIS

L2-S1 spinal canal stenosis, with abdominal aorta injury at the L2-L3 level during lumbar fusion surgery via a posterior approach.

INTERVENTIONS

L2-S1 decompression and fusion via a posterior approach was employed for spinal canal stenosis. Transluminal angioplasty with stent placement was successfully performed to stop the bleeding.

OUTCOMES

During the procedure, it was decided that staunching the active bleeding was necessary and attention should be paid to the vital signs and blood pressure. Vascular surgical intervention was immediately scheduled when the blood pressure dropped. After stent placement, hemodynamic parameters stabilized.

CONCLUSION

In this case report we review the prevalent sites, predisposing risk factors, diagnosis, and treatment of acute abdominal aortic injury during posterior lumbar fusion surgery, in view of our case findings. Although the incidence of vascular injury during lumbar fusion surgery is low, it is often easily overlooked. Consequently, during surgery, physicians should always be alert to the risk of vascular injury and master its clinical characteristics. Once injury is suspected, active and effective measures should promptly be taken for diagnosis and treatment to avoid serious adverse consequences.

Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review

Iatrogenic vascular laceration is a rare but well-known complication of posterior lumbar disc surgery (PLUDS). We performed a review of the literature to evaluate the management of this life-threatening complication. A total of 54 papers containing 100 cases of vascular laceration following PLUDS between 1969 and 2018 were analyzed with our representative case with a left common iliac artery (CIA) laceration during a posterior approach for a far lateral L4-L5 disc herniation. There were 54 females and 35 males (12 cases with unreported gender) with ages ranging from 20 to 72 years. The most commonly involved spinal level was L4-L5 (n = 67). The duration from the causative surgery to the symptom of the vascular injury ranged from 0 to 50 h (mean, 7.3 h). Only 47.3% of patients underwent postoperative imaging and the most commonly injured vessel was the CIA (n = 49). Vascular repair, open surgery, and/or an endovascular procedure was performed in 95 patients. The most frequent complications were deep venous thrombosis in the leg and pulmonary emboli, where a complete recovery was seen in 75.3% of patients. The mortality rate was 18.8%. In hemodynamically unstable cases, an emergent exploratory laparotomy was life-saving even without vascular imaging, although angiography with/without endovascular intervention may be used in stable patients.

Iatrogenic Arteriovenous Fistula and Retroperitoneal Hemorrhage After Tapping of Lumbar Pedicle Screws: A Case Report

CASE

A 76-year-old woman underwent L4-L5 posterior lumbar interbody fusion with pedicle screws for lumbar spondylolisthesis. Intraoperative iatrogenic injuries to the right fourth lumbar artery and inferior vena cava occurred, resulting in arteriovenous fistula with extensive retroperitoneal hemorrhage. Endovascular treatment and intraperitoneal drainage were effective in managing retroperitoneal hemorrhage. She showed no sign of organ failure or deep venous thrombosis during her 2-year follow-up.

CONCLUSIONS

We recommend embolization both proximally and distally in the case of lumbar artery injury. Intra-abdominal hypertension secondary to a massive retroperitoneal hematoma should also be considered to prevent abdominal compartment syndrome.

Pulmonary hypertension and severe right heart failure following lumbar spinal surgery

Pulmonary hypertension is a disease process affecting the pulmonary circulation and is defined by an increase in pulmonary artery pressure subsequently causing right ventricular failure. Vascular complications, including arteriovenous fistulae, are recognised, but are uncommon complications of spinal surgery. Arteriovenous fistulae increase venous return to the right heart and can induce a high-output cardiac state, mimicking pulmonary arterial hypertension and right heart failure. We present a 47-year-old man with a 1 year history of worsening dyspnoea, exertional pre-syncope and leg swelling presenting with severe right heart failure. The previous year, he had complex spinal surgery, which included discectomy, laminectomy and bilateral nerve reconstruction at L5-S1 level. Initial non-invasive investigations including echocardiography and chest imaging raised the possibility of right heart failure presumed secondary to pulmonary vascular disease. Clinical examination and right heart catheterisation were in keeping with a high cardiac output state, and invasive saturation monitoring was suggestive of a sub-diaphragmatic shunt. Subsequent imaging confirmed the presence of an iatrogenic ilio-iliac arteriovenous fistula. The patient underwent urgent endovascular repair, which resulted in resolution of his symptoms and haemodynamics. We describe the case and present a review of the relevant literature.

Iliac Artery Injury During Lumbar Disc Hernia Surgery

BACKGROUND

Vascular injury complications during lumbar discectomy are rare but potentially life-threatening. Therefore, an early diagnosis and effective treatment management is required for these complications.

CASE DESCRIPTION

A 50-year-old female patient was admitted to our outpatient clinic with severe back and right leg pain. She underwent surgery for right L4-5 extruded disc herniation with general anesthesia. Sudden arterial hemorrhage occurred during discectomy performed with straight disc forceps and was controlled using hemostatic materials, with no significant decrease in blood pressure. However, the patient became hypotensive near the end of the operation. The incision was quickly closed, and she was turned to supine position. Emergency abdominal ultrasound, computed tomography, and computed tomography angiography revealed an injury of the left main iliac artery, which was repaired by endovascular stenting. Laparotomy and Bogota bag were applied because of increased intrabdominal pressure at 3 hours postoperative. In addition, a retroperitoneal catheter was placed into the area of the right retroperitoneal hematoma on the first postoperative day. Tissue plasminogen activator was administered through the catheter. On postoperative day 3, the Bogota bag was removed, and the abdomen was closed. The patient was discharged without neurodeficit on day 27. Her abdominal fascial defect was closed with a synthetic graft after 5 months.

CONCLUSIONS

Although lumbar discectomy is one of the most commonly performed neurosurgical procedures, the routine rules of discectomy should not be neglected. Early detection and a multidisciplinary approach can help prevent mortality in the event of vascular injury.

The summary of experience of abdominal vascular injury related to posterior lumbar surgery

PURPOSE

To study the clinical and pathophysiologic characteristics and summarize the experience of treatment of abdominal vascular injury related to lumbar surgery.

METHODS

We analyzed patients who suffered abdominal vascular injury during lumbar surgery in our hospital retrospectively and reviewed related literature in the PUBMED database from 2002 to 2017. Combined with the existing treatment options and outcomes, we investigated further and summarized our findings.

RESULTS

With the data from our hospital, four cases of injuries were included, i.e., left common iliac artery and vein (CIA and CIV), left internal iliac artery, and inferior vena cava. Almost all of the patients (one exception) manifesting unstable haemodynamics were primarily treated by traditional vessel suture. After treatment, two patients died eventually, while the others recovered well at follow-up. With the reported data, 77 patients with the most frequently type of laceration (58.4%) were included. For vascular laceration, unstable haemodynamics was diagnosed in most of the patients (88.9%); CIA and CIV accounted for the all the most common patients (78.7%). Extracted from these data, traditional surgical method was selected to repair laceration prevalently (86.7%), while arteriovenous fistula and pseudoaneurysm were treated with an interventional procedure. Negative outcomes included two deaths, two suffered lower limb deep vein thrombosis, and two suffered graft infection.

CONCLUSIONS

Different treatment choices should be conducted depending on different injury characteristics and patients' condition. Moreover, early recognition and prompt treatment are critical components to successful rescue. When a vascular injury is suspected, ultrasonography and positive abdominal exploration are recommended together with unified leadership in the rescue team.

Internal iliac artery transposition for vascular reconstruction in a patient with life-threatening iatrogenic common iliac artery injury

Major vascular injury during surgery is life threatening and can be a nightmare for any surgeon.We share our experience of a 42-year-old woman where right common iliac artery and both common iliac veins were accidentally injured during lumbar discectomy leading to haemorrhagic shock. Patient was resuscitated and explored. A 4 cm segment of right common iliac artery was found lacerated along with perforations of both iliac veins. Proximal segment of internal iliac artery was mobilised quickly and vascular continuity was restored by end-to-end anastomosis of this segment to the proximal segment of common iliac artery after excising the damaged segment. Iliac veins were repaired primarily. Patient made an uneventful recovery. We share this technique as it was found expeditious and effective and may benefit surgeons working in this field.

Lumbar Artery Injury during Transforaminal Percutaneous Endoscopic Lumbar Discectomy: Successful Treatment by Emergent Transcatheter Arterial Embolization

Injury to the lumbar artery during percutaneous endoscopic lumbar discectomy (PELD) is a very severe complication and only rarely reported. We present a 64-year-old patient with an injury to the right third lumbar artery during PELD which was successfully treated with intraoperative angiography and coil embolization. To our knowledge, this is the first report of the use of intraoperative angiography and coil embolization to treat a lumbar artery that had been lacerated during PELD.

Vascular Complications Related to Posterior Lumbar Disc Surgery

Purpose

To evaluate patients who underwent surgical or endovascular treatment after vascular injury related to posterior lumbar disc surgery.

Materials and Methods

We retrospectively reviewed seven cases of vascular injuries (four lacerations, one arteriovenous fistula [AVF], and two pseudoaneurysms) related to lumbar disc surgery by a posterior approach from January 1997 to December 2016 at Chonnam National University Hospital. Information of patient characteristics, diagnosis, treatment strategies, and outcomes were analyzed.

Results

Five out of seven cases were inhospital cases. In three laceration cases, each patient instantly became hypotensive and a life-threatening arterial injury was suspected. Therefore, the patient was immediately turned to the supine position and surgical repair was performed. The patients with pseudoaneurysm and AVF were treated by endovascular intervention. Remaining two were referred cases under the impression of vascular injuries. One laceration case of them was in preshock condition, and the left common iliac artery was surgically repaired. The other referred patient showed pseudoaneurysm which was treated with stent graft insertion. There was no surgery or endovascular intervention related death and none of the patients suffered any sequela related to vascular injury.

Conclusion

Vascular injury associated with posterior lumbar disc surgery is not common, but can be fatal. Early recognition, diagnosis, and prompt treatment are essential to prevent fatal outcomes. Recently, endovascular intervention is increasingly and preferably used because of its low morbidity and mortality. However surgery is still the best option for the patients with unstable vital sign and endovascular approach can be applied to stable patients.

Iatrogenic Vascular Injury Occurring during Discectomy in a Spondylodiscitis Patient

All iatrogenic vascular injury occurring during discectomy is a rare complication, but fatal if not immediately diagnosed. When a vascular injury is highly suspected during discectomy, immediate vascular evaluation is needed even vital signs are stable during and immediately after the operation. We describe a case of iatrogenic abdominal aortic injury that occurred during discectomy in a spondylodiscitis patient, which was treated by endovascular repair.

Silent killer: A scalpel in the aortic wall after spinal surgery

Iatrogenic vascular injury during lumbar spinal surgery is rare, but may lead to serious complications in unrecognized cases. Especially, injuries to aorta or its major branches may result in death unless diagnosed and treated immediately. We present a rare case of aortic injury with a scalpel in a 56-year-old male patient undergoing lumbar disk surgery. The vascular injury was successfully treated with open surgery. The post-operative period was uneventful and the patient was discharged in a healthy condition on the 8th day. This case once again reminds us that surgery is always open to complications and that early diagnosis and appropriate interventions are of paramount importance to overcome these complications.

[Vascular complications associated with lumbar spinal surgery]

Although there are currently less invasive techniques available for the treatment of spinal injuries, open surgery is still required in many cases. Vascular injuries occurring during lumbar spine surgery, although uncommon, are of great importance due to their potential gravity. Clinical manifestations vary from an acute hemorrhagic shock that needs urgent treatment to save the patient's life, to insidious injuries or an asymptomatic evolution, and should be studied to choose the best therapeutic alternative. Four cases are reported that represent this range of possibilities and emphasize the importance of a careful surgical technique during lumbar spine interventions, and the need for high clinical suspicion, essential for the early diagnosis of these vascular complications. The current therapeutic options are also discussed.

Incidence and clinical significance of vascular encroachment resulting from freehand placement of pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws

STUDY DESIGN

Retrospective case series.

OBJECTIVE

Evaluate the incidence and clinical significance of vascular encroachment resulting from freehand placement of pedicle screws in the thoracic and lumbosacral spine.

SUMMARY OF BACKGROUND DATA

Pedicle screws are routinely used to effectively stabilize all 3 columns of the spine but can be technically demanding to place in the setting of variable anatomy. There is a paucity of data regarding iatrogenic major vascular injuries during posterior instrumentation procedures.

METHODS

We retrospectively reviewed the records of all patients undergoing freehand pedicle screw placement without image guidance in the thoracic or lumbar spine during a 7-year period. The incidence and extent of vascular encroachment by a pedicle screw was determined by review of routine postoperative computed tomographic scans obtained within 24 hours of all surgical procedures. Vascular encroachment was defined as a pedicle screw that was touching or deforming the wall of a major vessel.

RESULTS

A total of 964 patients received 6816 freehand-placed pedicle screws in the thoracolumbar spine. Fifteen (0.22%) screws that encroached a major vascular structure were identified. Ten (0.29%) thoracic pedicle screws encroached on the aorta, 4 (0.14%) lumbar screws on the common iliac vein, and 1 S1 screw (0.19%) on the internal iliac vein. In consultation with vascular surgery, it was determined whether revision surgery and the technique/approach for the revision procedure should be recommended. Two (0.21%) patients required revision surgery to remove the encroaching pedicle screw (T5 and T8) due to concern for vascular injury. Both patients were asymptomatic and recovered without further complications after revision surgery.

CONCLUSION

Vascular encroachment of major vessels occurs rarely in the setting of freehand pedicle screw placement in the thoracolumbar spine. Although rare, delayed vascular injury from errant pedicle screw placement has been reported in the literature. The aorta seems to be the vessel at the highest risk of injury. Routine intraoperative or postoperative computed tomographic scanning allows for early identification of pedicle screws encroaching on vascular structures thereby facilitating early revision surgery.

LEVEL OF EVIDENCE

4.

A case of iliac artery injury treated by covered stent during carotid artery stenting

Here we describe a case of iliac artery injury during carotid artery stenting (CAS) treated by covered stent. A 74-year-old man underwent CAS for asymptomatic right carotid artery stenosis. Under local anesthesia, the right common femoral artery was punctured and an 8 Fr long sheath introducer was placed. However, the sheath kinked because the iliac artery was tortuous. We introduced the stylet to the sheath again and tried to extend the kinking. It failed, and the arterial dissection was identified at the lateral iliac artery. The kink was extended with triple coaxial system, i.e. guidewire, coaxial catheter, and a guiding catheter; CAS was performed with distal filter protection. Before removal of the sheath, the right iliac artery was examined, and extraversation of the contrast medium was observed. The balloon catheter was placed to the lesion and dilated for the hemostasis. However, it failed, and the covered stent was placed subsequently. Although blood tests revealed anemia and CT showed retroperitoneal hematoma after the treatment, further complication did not occur. Treatment with covered stent for the vessel injury was effective.

Innovative Technique of Vascular Repair in Intra-Operative IVC Rupture During Lumbar Microdiscectomy: A Case Report

Background

Major vascular injury during a spinal surgery is a rare but most dreaded complication.

Case Presentation

A 39 years old female undergoing microscopic lumbar discectomy suddenly developed severe hypotension on table. The procedure was abandoned and the patient turned supine. It was diagnosed to be a major vessel tear and the patient was taken up for immediate successful vascular repair. To best of our knowledge such a repair procedure has not been described in literature.

Conclusions

Majority of such vascular injuries are dealt with primary repair of the defect by a vascular surgeon; however in our case the rent was big and placed on the undersurface making it very difficult for the vascular surgeon to approach or repair it primarily.

A shift toward endovascular repair for vascular complications in lumbar disc surgery during the last decade

BACKGROUND

The purpose of this study is to evaluate 2 patients who underwent endovascular repair directly after acute life-threatening vascular injury complicating lumbar disc surgery, and to update an overview of the literature from 2002 to gain insights into characteristics, diagnosis, treatment, and outcomes of this rare, life-threatening complication.

METHODS

PubMed was searched for English language studies on vascular injury (lacerations, arteriovenous fistulas, and pseudoaneurysms) complicating lumbar disc surgery by a posterior approach published from 2002. Two cases from the authors' institute were added to the review. Information on patient characteristics, diagnosis, treatment strategies, and outcomes were extracted by 2 independent reviewers.

CASE REPORTS

The first case describes a 54-year-old man who underwent lumbar disc surgery through a posterior approach (L5-S1) and became hypotensive intraoperatively. Angiography revealed an injury of the right internal iliac artery. Bleeding was successfully repaired by endovascular repair (acute balloon occlusion followed by coiling). The second case describes a 51-year-old women who suddenly became hypotensive during L4 through L5 discectomy caused by bleeding from a laceration in the right common iliac artery. Angiography confirmed the diagnosis, and the bleeding was successfully treated through endovascular repair with a covered stent.

RESULTS

A total of 56 cases from 34 articles were found in the literature since 2002, including lacerations, arteriovenous fistulas, and pseudoaneurysms. Two cases from the authors' institute were added to the review. Vascular injury was recognized intraoperatively in 36%, and within 24 hours postsurgery in 28%. The common iliac artery was most frequently affected (51%), followed by the iliac vein (23%). All lacerations were detected during surgery, whereas most arteriovenous fistulas and pseudoaneurysms were detected in the long term. Treatment consisted of open surgical repair (57%) or endovascular repair (43%). All patients survived surgery.

CONCLUSIONS

Publication bias might play a role in the literature of this area because all cases survived surgery, whereas mortality rates for this condition are high. However, early recognition, diagnosis, and prompt surgical repair are essential to prevent fatal outcomes in vascular injuries complicating lumbar disc surgery. Endovascular repair is a minimally invasive, fast, and efficient treatment modality that is increasingly and preferably used because of its low morbidity and mortality.

Injury to major abdominal vessels during posterior lumbar interbody fusion. A case report and review of the literature

BACKGROUND CONTEXT

Numerous cases of injury to major abdominal vessels during the excision of a lumbar herniated disc have been reported, but no cases of injury during interbody fusion by a posterior approach have been described.

PURPOSE

To report on an injury to common iliac vessels during a posterior lumbar interbody fusion (PLIF) and discuss the causes and possible preventive measures.

STUDY DESIGN

A unique case report and a review of the literature.

METHODS

The hospital chart and autopsy report of a single patient were analyzed.

RESULTS

A 52-year-old woman with L4-L5 disc degeneration underwent PLIF. During scraping of the vertebral end plates, there was a sudden increase in blood flow from the disc space, however not copious, with no changes of vital parameters. When the patient was placed supine, severe hypotension and abdominal distension led to strongly suspect a lesion to abdominal vessels. At laparotomy, carried out by a vascular surgeon, a vast retroperitoneal hematoma was evacuated and the vascular lesions were repaired. Postoperatively, the patient continued to lose blood from the abdominal drains and after 4 hours, she was reoperated by another vascular surgeon, who found a diffuse hemorrhage from the small vessels in the surgical field. Soon after the surgery the patient died.

CONCLUSIONS

The lesions were produced by a shaver used for scraping the vertebral end plates. The absence of abundant bleeding from the disc space was possibly because of the compression of the iliac vessels by the pads of the frame on which the patient was lying. The causes of the lesions and possible prevention of similar injuries are analyzed.

Right iliac aortic aneurysmal hemorrhage as a complication of lumbar discectomy

BACKGROUND

Vascular injury is rarely reported but can be a life-threatening complication after lumbar disc surgery.

CASE DESCRIPTION

We report a case of the rupture of a pseudoaneurysm of the right common iliac artery after spinal surgery for herniation of an intervertebral disc. It was successfully treated by prompt surgical repair.

CONCLUSION

This case reminds us of this rare but possible complication, and emphasizes the importance of early diagnosis and urgent intervention.

Iliac artery perforation and treatment during lumbar disc surgery by simple balloon tamponade

INTRODUCTION

Although vascular injury during lumbar disc surgery is quite rare, it may be life threatening if not recognized and treated immediately.

CASE

We report the case of a woman who had a left common iliac artery laceration during spinal surgery and was treated by endovascular therapy. In the past, open surgery was the only way to repair a vascular injury, but thanks to the advance of new endovascular techniques and devices, endovascular therapy has become a strong alternative.

CONCLUSION

This case differs from those published in the literature as we used a single balloon inflation and subtotal occlusion without the need for a covered stent.

Combined endovascular and neurosurgical approach to the removal of an intraaortic pedicle screw

Iatrogenic aortic injuries are a potentially devastating complication of spine surgery. In instrumented cases, injuries may occur in the perioperative period due to iatrogenic vessel injury, or they may occur years later as prominent implants erode or penetrate major vessels. The authors present a case of a 71-year-old man in whom a thoracic pedicle screw was found perforating the thoracic aorta during routine follow-up 6 months after surgery. Due to the risk of future complications, the screw was removed while simultaneously delivering an endovascular aortic stent to gain vascular control. Surgical considerations and potential technical limitations are discussed.

Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery

OBJECTIVE

This study aims to describe the endovascular management of abdominal-aortic- or common-iliac-artery injuries after lumbar-spine surgery.

METHODS

Patients treated for abdominal-aortic- or common-iliac-artery injuries after lumbar-spine surgery during a 13-year period were identified from an endovascular database, providing prospective information on techniques and outcome. The corresponding patient records and radiographic reports were analysed retrospectively.

RESULTS

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.

CONCLUSIONS

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.

Vascular injury in thoracolumbar spinal surgeries and role of angiography in early diagnosis and management

STUDY DESIGN

A retrospective outcomes study.

OBJECTIVE

To stress on the importance of early diagnosis with the help of angiography and proper treatment of vascular injuries occurring during thoracolumbar surgeries and to report our results.

SUMMARY OF BACKGROUND DATA

Vascular injury is a rare but dangerous complication that can develop during thoracolumbar surgeries and if not treated properly then it can lead to severe complications including the death of the patient.

METHODS

The patients included in this study were the ones who were suspected to have a possible vascular injury after a thoracolumbar surgery. Contrast enhanced computed tomography was performed for patients having clinical signs suggesting vascular injury. Among these patients, who were suspected to have active bleeding and major vessel injury on computed tomography were further subjected to angiography.

RESULTS

Of the 10 cases included in the study, vascular injury was identified to be arterial in origin in 8 cases and venous in 3 cases. Among the 8 cases of identified arterial injury, angiography was performed in 4 cases, of which 3 were found to have active bleeding and were subjected to immediate intervention. Of the 4 cases in which angiography was not performed, 3 of them expired at variable postoperative periods. Complications developed in total 5 cases including 3 cases of mortality, 1 case of infection, and 1 case of cauda equina syndrome.

CONCLUSIONS

The vascular injuries during thoracolumbar spinal surgeries need immediate and aggressive treatment. In arterial injuries, we can prevent serious consequences by subjecting the patient to an angiography as early as possible followed by a therapeutic embolization. In contrast, for venous injuries if hemostasis has been confirmed, then an immediate intervention may not be always required.

Endovascular treatment for common iliac artery injury complicating lumbar disc surgery : limited usefulness of temporary balloon occlusion

Vascular injury during lumbar disc surgery is a rare but potentially life-threatening complication. It has been managed by open vascular surgical repair. With recent technologic advance, endovascular treatment became one of effective treatment modalities. We present a case of a 32-year-old woman who suffered with common iliac artery injury during lumbar disc surgery that was treated successfully by endovascular repair with temporary balloon occlusion and subsequent insertion of a covered stent. Temporary balloon occlusion for 1.5 hours could stop bleeding, but growing pseudoaneurysm was identified at the injury site during the following 13 days. It seems that the temporary balloon occlusion can stall bleeding from arterial injury for considerable time duration, but cannot be a single treatment modality and requires subsequent insertion of a covered stent.