title: Vascular injury in thoracolumbar spinal surgeries and role of angiography in early diagnosis and management.
abstract: 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.
authors.affiliation: Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hak Sun
authors.initials: HS
authors.lastname: Kim
authors.forename: Hyon Su
authors.initials: HS
authors.lastname: Chong
authors.forename: Ankur
authors.initials: A
authors.lastname: Nanda
authors.forename: Jin Oh
authors.initials: JO
authors.lastname: Park
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Moon
authors.forename: Hwan Mo
authors.initials: HM
authors.lastname: Lee
authors.forename: Ho Joong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Chun Kun
authors.initials: CK
authors.lastname: Park
authors.forename: Ye Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Suk Ha
authors.initials: SH
authors.lastname: Lee
authors.forename: Eun Su
authors.initials: ES
authors.lastname: Moon
mesh_terms: 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