title: Vascular complications from anterior spine surgery in three patients with Ehlers-Danlos syndrome.
abstract: METHODS
  A case report of vascular complications arising from anterior spine surgery in 3 patients with Ehlers-Danlos syndrome (EDS).
  
  
  OBJECTIVE
  The aim of the article is to describe complications of anterior spine surgery in 3 patients with EDS.
  
  
  BACKGROUND
  Scoliosis can be a skeletal manifestation of EDS. Anterior approaches to the spine are sometimes used during scoliosis surgery to gain more correction than otherwise possible. A literature search revealed no published articles focusing on major vascular bleeding during anterior spine surgery in EDS patients as the specific topic.
  
  
  METHODS
  Review of records and radiographs.
  
  
  RESULTS
  Three patients with EDS and severe scoliosis underwent an anterior and posterior release followed by posterior fusion. Major bleeding was encountered during anterior surgery in all 3 patients. Sources of bleeding included a torn external iliac artery, avulsed segmental arteries, and the abdominal aorta. Blood loss ranged from 600 mL to 6 L. All vessels were repaired with sutures and synthetic grafts. In all 3 patients, posterior fusion was met with no complications and their curves were stable at follow-up.
  
  
  CONCLUSIONS
  These complications may be explained by the fragility of blood vessels secondary to the collagen defect in EDS. Though methods exist to decrease these complications, they may not be enough to prevent catastrophic bleeding. For EDS patients, risk of vascular complications during anterior surgery of the spine is high and surgeons should be aware of this when developing a surgical plan.
authors.affiliation: Department of Orthopedic Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Yang
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.forename: Muharrem
authors.initials: M
authors.lastname: Yazici
authors.forename: Charles E
authors.initials: CE
authors.lastname: Johnston
mesh_terms: D000293:Adolescent; D001012:Aorta, Abdominal / Q000473:pathology; D001019:Aortic Rupture / Q000209:etiology / Q000473:pathology; D016063:Blood Loss, Surgical / Q000517:prevention & control; D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D017586:Diskectomy / Q000009:adverse effects*; D004535:Ehlers-Danlos Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D008297:Male; D011859:Radiography; D012421:Rupture; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013536:Suture Techniques; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery