Case report: intraoperative left common iliac occlusion in a scheduled 360-degree spinal fusion.

Abstract

This is a case report of a left common iliac artery occlusion identified as an intraoperative complication during a planned (combined anterior interbody and posterior fusion) 360 degrees spinal fusion. The purpose of this report was to document the occurrence of this rare complication during a planned 360 degrees fusion and to increase the awareness of this potential intraoperative vascular complication. Several cases of left iliac artery occlusion after anterior spinal surgery have been reported, but there has been no reported case of intraoperative iliac artery occlusion identified during a planned 360 degrees spinal fusion. The patient was a 46-year-old woman with chronic low and mid back pain and left leg pain for several years. She was a 2-pack-a-day cigarette smoker for 30 years. She was diagnosed with internal disc disruption at L3-L4 and L4-L5, unresponsive to nonoperative treatment, and was scheduled for a 360 degrees spinal fusion. During the anterior procedure, the left iliac vessels were retracted with a Wiley retractor during the discectomy and fusion. It was noted that there was no pulse in the left common iliac artery as the anterior procedure neared completion. Intraoperative Doppler showed the left iliac artery was occluded, and a left iliac endarterectomy and thrombectomy were performed immediately. A significant occlusive plaque was separated distally and transected in a smooth fashion, and fresh thrombus was also removed. The procedure was successfully accomplished without any further complication with excellent restoration of arterial blood flow to the left lower extremity. Doppler study showed good triphasic flow in the iliac artery and all its branches. Because of the arterial repair, the posterior portion of the surgery was not undertaken at that time and was performed 2 weeks later. Early recognition and appropriate treatment can prevent serious sequelae. Great care and observation should be given to the patients before surgery, intraoperatively, as well as after surgery.