Spinal screw penetration of the aorta.

Aortic injury is a complication of spinal instrumentation with treatment challenges, especially with hardware infection. We present two cases of spinal screws penetrating the descending thoracic aorta (DTA). Case 1 had pain after T6-T7 fusion with screw penetration of the DTA causing pseudoaneurysm. Case 2 had perforation of the DTA by a T4 screw with infected pseudoaneurysm. Neither was an endovascular candidate and both underwent open repair. Although endovascular approaches have benefits in aortic aneurysm repair, the techniques of open thoracic aortic repair remain relevant.