Abstract
PurposeTo assess the rate, timing of diagnosis, and repairing strategies of vascular injuries in thoracic and lumbar spine surgery as their relationship to the approach.MethodsPubMed, Medline, and Embase databases were utilized for a comprehensive literature search based on keywords and mesh terms to find articles reporting iatrogenic vascular injury during thoracic and lumbar spine surgery. English articles published in the last ten years were selected. The search was refined based on best match and relevance.ResultsFifty-six articles were eligible, for a cumulative volume of 261 lesions. Vascular injuries occurred in 82% of instrumented procedures and in 59% during anterior approaches. The common iliac vein (CIV) was the most involved vessel, injured in 49% of anterior lumbar approaches. Common iliac artery, CIV, and aorta were affected in 40%, 28%, and 28% of posterior approaches, respectively. Segmental arteries were injured in 68% of lateral approaches. Direct vessel laceration occurred in 81% of cases and recognized intraoperatively in 39% of cases.ConclusionsIncidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery is low but associated with an overall mortality rate up to 65%, of which less than 1% for anterior approaches and more than 50% for posterior ones.Anterior approaches for instrumented procedures are at risk of direct avulsion of CIV. Posterior instrumented fusions are at risk for injuries of iliac vessels and aorta. Lateral routes are frequently associated with lesions of segmental vessels. Suture repair and endovascular techniques are useful in the management of these severe complications.
Highlights
Vascular injuries are rare but potentially life-threatening complications in thoracic and lumbar spinal surgery, having a reported incidence of 0.01% to 1%, and variable overall mortality that ranges between 15 and 65% [1–3].The widening of the spectrum of the surgical corridors for the treatment of spinal diseases, frequently involving the dissection and mobilization of the major splanchnic vessels, has increased the risk of vascular injuries [4–7]
Our study demonstrated that 33% of vascular injuries occurred during posterior approaches, of which only 24% happened during instrumented surgery
The literature reported an overall incidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery which is not negligible
Summary
Vascular injuries are rare but potentially life-threatening complications in thoracic and lumbar spinal surgery, having a reported incidence of 0.01% to 1%, and variable overall mortality that ranges between 15 and 65% [1–3].The widening of the spectrum of the surgical corridors for the treatment of spinal diseases, frequently involving the dissection and mobilization of the major splanchnic vessels, has increased the risk of vascular injuries [4–7]. Vascular injuries are rare but potentially life-threatening complications in thoracic and lumbar spinal surgery, having a reported incidence of 0.01% to 1%, and variable overall mortality that ranges between 15 and 65% [1–3]. Clinical presentation is not always recognized, especially when the injury is related to a posterior approach. Delayed injuries can occur days, weeks, or even months following the procedure. They are characterized by a widening of the arterial pressure and tachycardia, which are possibly related formation of thrombi, pseudoaneurysms, or arteriovenous fistulas [12–16]. One difficulty to recognize the cause of delayed vascular injury relates to progressive damage to the vessel wall by prominent hardware [17–21]
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