Patrick C Bonasso1, Brandon P Lucke-Wold2, Alexandre d'Audiffret2, Lakshmikumar Pillai2. 1. Department of Vascular Surgery, West Virginia University School of Medicine, Morgantown, WV. Electronic address: Pbonass3@hsc.wvu.edu. 2. Department of Vascular Surgery, West Virginia University School of Medicine, Morgantown, WV.
Abstract
BACKGROUND: Rates of major venous injury are now being reported at between 1% and 15%. Risk factors for injury include the previous spine surgery, level of exposure, and number of retractors used. To review and describe the evolution of our use of stent grafts for repair of life-threatening ilio-caval injuries encountered during anterior exposure lumbosacral (L-S) spine surgery from rescue utilization after failed direct repair to preferred modality using occlusion balloons and covered stents akin to the modern management of the ruptured abdominal aortic aneurysm (AAA) with endovascular aneurysm repair. METHODS: Five-year retrospective review of all anterior and retroperitoneal spine procedures was performed at our institution. RESULTS: One hundred two procedures were done. Major ilio-caval injury occurred in 3/102 (2.9%) cases. Average blood loss per case decreased as our approach evolved from unsuccessful direct open repair with percutaneous endovascular rescue to primary percutaneous endovascular repair. All treated patients had patent venous repair in short-term follow-up with computed tomography angiography. CONCLUSIONS: Identification and rapid direct repair of major ilio-caval injuries during anterior approach spine surgery can be extremely challenging. When control of these potentially fatal injuries is required, our choice is primary endovascular repair using the modern techniques for endovascular management of ruptured AAA with endovascular aneurysm repair.
BACKGROUND: Rates of major venous injury are now being reported at between 1% and 15%. Risk factors for injury include the previous spine surgery, level of exposure, and number of retractors used. To review and describe the evolution of our use of stent grafts for repair of life-threatening ilio-caval injuries encountered during anterior exposure lumbosacral (L-S) spine surgery from rescue utilization after failed direct repair to preferred modality using occlusion balloons and covered stents akin to the modern management of the ruptured abdominal aortic aneurysm (AAA) with endovascular aneurysm repair. METHODS: Five-year retrospective review of all anterior and retroperitoneal spine procedures was performed at our institution. RESULTS: One hundred two procedures were done. Major ilio-caval injury occurred in 3/102 (2.9%) cases. Average blood loss per case decreased as our approach evolved from unsuccessful direct open repair with percutaneous endovascular rescue to primary percutaneous endovascular repair. All treated patients had patent venous repair in short-term follow-up with computed tomography angiography. CONCLUSIONS: Identification and rapid direct repair of major ilio-caval injuries during anterior approach spine surgery can be extremely challenging. When control of these potentially fatal injuries is required, our choice is primary endovascular repair using the modern techniques for endovascular management of ruptured AAA with endovascular aneurysm repair.
Authors: Salvador A Brau; Rick B Delamarter; Michael L Schiffman; Lytton A Williams; Robert G Watkins Journal: Spine J Date: 2004 Jul-Aug Impact factor: 4.166
Authors: Allen D Hamdan; Junaid Yusuf Malek; Marc L Schermerhorn; Bernadette Aulivola; Seth B Blattman; Frank B Pomposelli Journal: J Vasc Surg Date: 2008-06-30 Impact factor: 4.268
Authors: Gary A Fantini; Ioannis P Pappou; Federico P Girardi; Harvinder S Sandhu; Frank P Cammisa Journal: Spine (Phila Pa 1976) Date: 2007-11-15 Impact factor: 3.468