title: Hybrid approach for removal of an errant intra-vascular pedicle spinal fixation screw in the thoracic aorta.
abstract: Late presentation of aortic injuries secondary to internal fixation hardware is uncommon and generally associated with pseudoaneurysm formation. We herein present a case of transmural migration of a pedicle screw into the descending thoracic aorta, which was revealed incidentally by computed tomography scan after almost 4 years of hardware implantation. Approximately 75% of the pedicle screw was exposed to the bloodstream, and was successfully removed using endovascular segmental exclusion to avoid aortic cross-clamping and an open approach via left thoracotomy. This case illustrates the successful repair of an iatrogenic aortic injury using a hybrid technique.
authors.affiliation: Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, TX, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Colvard
authors.forename: Javier E
authors.initials: JE
authors.lastname: Anaya-Ayala
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Smolock
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lumsden
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Reardon
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D001863:Bone Screws / Q000009:adverse effects*; D020878:Device Removal; D017586:Diskectomy; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D011859:Radiography; D013904:Thoracic Vertebrae / Q000601:surgery; D013908:Thoracotomy