Successful Endovascular Surgery for Iatrogenic Common Iliac Artery Injury during Lumbar Spine Surgery: A Case Report

July 29, 2022

Case Reports

doi: 10.3390/medicina58070927.

Affiliations

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Case Reports

Chien-Ming Chin et al.

Medicina (Kaunas).

2022.

doi: 10.3390/medicina58070927.

Affiliations

¹ Department of Orthopedics, Hualien Tzu Chi Hospital, Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan.
² Sports Medical Center, Hualien Tzu Chi Hospital, Hualien 970, Taiwan.
³ Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.

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Abstract

An 80-year-old man was admitted with an L5 compression fracture, L4/5 spondylolisthesis, and L5 radiculopathy and underwent a TLIF procedure. Refractory hypotension occurred, though it indicated a possible great vessel injury with vasopressor and fluid infusion. Emergent intraoperative angiography was performed, which showed extravasation at the right common iliac artery. Resuscitative endovascular balloon occlusion of the aorta followed by right common iliac artery stenting was successfully performed to arrest the bleeding. The iatrogenic right common iliac artery laceration was complicated with abdomen compartment syndrome and acute kidney injury. The patient received supportive care, including continuous venovenous hemofiltration (CVVH) for a week, after which the patient’s condition improved. The patient did not have any residual complications at the one-month follow-up. Great vessel injury during the TLIF procedure is rare but fatal. Refractory hypotension is indicative of a great vessel injury. Endovascular intervention is a fast and promising method to diagnose and treat arterial injury.

Keywords:

case report; endovascular surgery; iatrogenic common iliac artery injury; lumbar spine surgery.

Conflict of interest statement

The authors have no conflict of interest to disclose.

Figures

**Figure 1**

Images of preoperative. (A) Lateral X-ray view of the lumbar spine. (B) Sagittal T2EI FSE MRI and (C) sagittal STIR MRI L5 old compression fracture, L4/5 spondylolisthesis. (D,E) Axial T2WI FSE MRI showed L4/5 lateral recess stenosis and severe central stenosis. Images (E) showed the pre-operative vascular position of the L5 vertebral body, which is indicated by a red circle symbol (right common iliac artery) and a blue circle symbol (inferior vena cava around the bifurcation).

**Figure 2**

Intra-operative angiography and post-operative X-ray. (A) Contrast extravasation vias the right common iliac artery, which is indicated by a black arrow. (B) A stent was placed to repair the laceration. (C) Demonstrate stent insertion.

**Figure 3**

Post-operative CT. (A,B) Bilateral retroperitoneal hematoma, especially at the right side, which is indicated by a white arrow symbol. (C) Post-operative three months showed totally resolution of retroperitoneal hematoma.

References

1. Vaccaro A.R., Kepler C.K., Rihn J.A., Suzuki H., Ratliff J.K., Harrop J.S., Morrison W.B., Limthongkul W., Albert T.J. Anatomical Relationships of the Anterior Blood Vessels to the Lower Lumbar Intervertebral Discs: Analysis based on magnetic resonance imaging of patients in the prone position. J. Bone Jt. Surg. 2012;94:1088–1094. doi: 10.2106/JBJS.K.00671.
  
  –
  
  DOI
  
  –
  
  PubMed
1. Papadoulas S., Konstantinou D., Kourea H., Kritikos N., Haftouras N., Tsolakis J. Vascular Injury Complicating Lumbar Disc Surgery. A Systematic Review. Eur. J. Vasc. Endovasc. Surg. 2002;24:189–195. doi: 10.1053/ejvs.2002.1682.
  
  –
  
  DOI
  
  –
  
  PubMed
1. Ewah M.B., Calder M.I. Intraoperative death during lumbar discectomy. Br. J. Anaesth. 1991;66:721–723. doi: 10.1093/bja/66.6.721.
  
  –
  
  DOI
  
  –
  
  PubMed
1. Goodkin R., Lewis L.L. Vascular and Visceral Injuries Associated with Lumbar Disc Surgery: Medicolegal Implications. Surg. Neurol. 1998;49:358–372. doi: 10.1016/S0090-3019(97)00372-8.
  
  –
  
  DOI
  
  –
  
  PubMed
1. Van Zitteren M., Fan B., Lohle P.N., de Nie J.C., Malefijt J.D.W., Vriens P.W., Heyligers J.M. A Shift Toward Endovascular Repair for Vascular Complications in Lumbar Disc Surgery During the Last Decade. Ann. Vasc. Surg. 2013;27:810–819. doi: 10.1016/j.avsg.2012.07.019.
  
  –
  
  DOI
  
  –
  
  PubMed