Endovascular graft for late iatrogenic vascular complication after anterior spinal instrumentation: a case report.
METHODS
Case report.


OBJECTIVE
To describe an endovascular treatment option for (late) vascular complications after anterior spinal instrumentation.


BACKGROUND
Severe progressive scoliosis is a well-known feature in Marfan's disease. Although overall complication rate after surgical correction of the spinal deformity is rather high, late iatrogenic complications are less frequently identified.


METHODS
A 40-year-old woman with Marfan's disease reported to our outpatient clinic with dyspnoe d'effort, 20 years after anterior spinal instrumentation of a thoracolumbar scoliosis. Routine screening identified a saccular aneurysm of the descending thoracic aorta. A contrast-enhanced CT scan revealed that the most proximal screw of the construct had perforated the vessel wall and caused a false aneurysm. An endovascular approach to the problem was chosen; by a transfemoral approach, an AneuRx endovascular graft was successfully implanted.


RESULTS
The patient had an uneventful postoperative course and was discharged within 5 days. At 5-year follow-up, the patient still has no clinical complaints, nor radiographic leakage nor recurrence of the false aneurysm at contrast-enhanced CT screening.


CONCLUSIONS
Use of an endovascular graft is an adequate alternative for treatment of late vascular complications after anterior spinal instrumentation.
Been
Henk D
HD
Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands. H.D.Been@amc.uva.nl
Kerkhoffs
Gino M M J
GM
Balm
Ron
R
D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D001863:Bone Screws / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008382:Marfan Syndrome / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects; D019737:Transplants