J Korean Neurosurg Soc.  2012 Apr;51(4):227-229. 10.3340/jkns.2012.51.4.227.

Management of Proximal Iliac Artery Injury during Lumbar Discectomy with Stent Graft

• Jin SC
• Park SW
• Cho DS

• KMID: 2066916
• DOI: http://doi.org/10.3340/jkns.2012.51.4.227

Abstract

Iatrogenic vascular injuries during lumbar disc surgery may occur rarely but they are serious complications, which can be fatal without appropriate management. Prompt diagnosis and management of these complications are imperative to prevent a desperate outcome. A 72-year-old female with proximal left common iliac artery iatrogenic injury during lumbar discectomy was successfully treated by percutaneous deployment of a stent graft in an emergency setting. Postprocedural angiogram demonstrated complete exclusion of the iliac artery laceration. The patient became hemodynamically stable. Two weeks later she complained of vascular claudication. Follow-up angiography revealed decreased arterial flow in the opposite common iliac artery. An additional kissing stent was inserted into the right common iliac artery and the symptoms of vascular claudication disappeared. Endovascular stenting offers a safe and effective method for the treatment of an iatrogenic arterial laceration, particularly in a critical condition. But, the contralateral iliac arterial flow should be kept intact in case of proximal iliac artery injury. Otherwise, additional treatments may be needed.

Keyword

Vascular injury; Discectomy; Lumbar disc surgery; Stent

MeSH Terms

Aged
Angiography
Diskectomy
Emergencies
Female
Follow-Up Studies
Humans
Iliac Artery
Lacerations
Stents
Transplants
Vascular System Injuries

Figure

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  Fig. 1 Angiography demonstrates a laceration of the left iliac artery just below the aortic bifurcation with contrast leakage.

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  Fig. 2 Endovascular repair with a covered stent extending from aortic bifurcation to the bifurcation of the left common iliac artery.

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  Fig. 3 Angiography shows decreased arterial flow in the right common iliac artery.

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  Fig. 4 Angiogram showing an additional kissing stent in the right common iliac artery and an improved blood flow in both the common iliac arteries.

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