Vascular injury in thoracolumbar spinal surgeries and role of angiography in early diagnosis and management.
METHODS
A retrospective outcomes study.


OBJECTIVE
To stress on the importance of early diagnosis with the help of angiography and proper treatment of vascular injuries occurring during thoracolumbar surgeries and to report our results.


BACKGROUND
Vascular injury is a rare but dangerous complication that can develop during thoracolumbar surgeries and if not treated properly then it can lead to severe complications including the death of the patient.


METHODS
The patients included in this study were the ones who were suspected to have a possible vascular injury after a thoracolumbar surgery. Contrast enhanced computed tomography was performed for patients having clinical signs suggesting vascular injury. Among these patients, who were suspected to have active bleeding and major vessel injury on computed tomography were further subjected to angiography.


RESULTS
Of the 10 cases included in the study, vascular injury was identified to be arterial in origin in 8 cases and venous in 3 cases. Among the 8 cases of identified arterial injury, angiography was performed in 4 cases, of which 3 were found to have active bleeding and were subjected to immediate intervention. Of the 4 cases in which angiography was not performed, 3 of them expired at variable postoperative periods. Complications developed in total 5 cases including 3 cases of mortality, 1 case of infection, and 1 case of cauda equina syndrome.


CONCLUSIONS
The vascular injuries during thoracolumbar spinal surgeries need immediate and aggressive treatment. In arterial injuries, we can prevent serious consequences by subjecting the patient to an angiography as early as possible followed by a therapeutic embolization. In contrast, for venous injuries if hemostasis has been confirmed, then an immediate intervention may not be always required.
Kim
Hak Sun
HS
Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Chong
Hyon Su
HS
Nanda
Ankur
A
Park
Jin Oh
JO
Moon
Seong Hwan
SH
Lee
Hwan Mo
HM
Kim
Ho Joong
HJ
Park
Chun Kun
CK
Park
Ye Soo
YS
Lee
Suk Ha
SH
Moon
Eun Su
ES
D000328:Adult; D000368:Aged; D000792:Angiography; D001808:Blood Vessels / Q000293:injuries*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology