Right Iliac Aortic Aneurysmal Hemorrhage as a Complication of Lumbar Discectomy

Chao, Chien‐Ming; Wu, Chung-Da; Sung, K. C.; Lin, Wei−Ting; Lee, Kun-Kuang; Lai, Chih‐Cheng

doi:10.1016/j.wneu.2012.09.014

Cited by 5 publications

(6 citation statements)

References 9 publications

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“…A pseudoaneurysm, unlike a true aneurysm, which is a partial expansion of vessel diameter by 1.5 times and consisting of all 3 layers of the vessel wall tissues, is a partial arterial defect which results in vascular leaks surrounded by soft tissue, a hematoma, or a thin fibrous capsule, forming patent turbulent blood flow in a defined space beyond the confines of the vessels. A pseudoaneurysm is mainly caused by iatrogenic injury (vascular interventional treatment, [ 11 ] lumbar disc surgery, [ 21 ] kidney transplantation, [ 22 ] etc), infection (bacteria, [ 23 , 24 ] tuberculosis, [ 25 ] or fungi [ 26 ] ), some diseases (lymphoma, [ 27 ] Behcet disease, [ 28 – 30 ] etc), and noniatrogenic trauma. Hematomas form surrounding the injured portion of the vessel where lysis occurs as time proceeds, creating a confined space with an intravascular–extravascular connection, thus forming a pseudoaneurysm.…”

Section: Discussionmentioning

confidence: 99%

Rupture of multiple pseudoaneurysms as a rare complication of common iliac artery balloon occlusion in a patient with placenta accreta

Peng

Zhang

2018

Medicine

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Rationale:Placenta accreta is the main cause of severe obstetric postpartum hemorrhage (PPH) and hysterectomy. Several hemostatic techniques have been performed in patients with placenta accreta to prevent PPH and reserve fertility. Abdominal aorta and pelvic arteries balloon occlusion are the only techniques which could be performed before cesarean section (CS) in patients who want to keep the fetus and reserve fertility. However, abdominal aorta and pelvic arteries balloon occlusion might lead to severe complications such as formation and rupture of pseudoaneurysm, angiorrhexis, etc.Patient concerns:We report a case diagnosed with pernicious placenta previa (PPP) combined with Rh(D) negative blood type, who was performed with bilateral common iliac arteries (CIA) balloon occlusion during CS. However, on the first day after CS, the patient caught sudden left-side lumbago and backache accompanied with palpitation and shortness of breath.Diagnoses:Formation and rupture of multiple pseudoaneurysms in left CIA.Interventions:Covered stent was inserted into the proximal part of the left CIA and the ipsilateral internal iliac artery was embolized by coil to prevent endoleak.Outcomes:The patient recovered and discharged from hospital in stable condition without other complications 9 days after CS.Lessons:It is of paramount importance that obstetricians and radiologists correctly estimate the appropriate occlusion volume and pressure of pelvic arteries before CS to avoid formation and rupture of a pseudoaneurysm. And if the rupture of a pseudoaneurysm occurred, it should be quickly identified and treated with endovascular intervention.

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Section: Discussionmentioning

confidence: 99%

Rupture of multiple pseudoaneurysms as a rare complication of common iliac artery balloon occlusion in a patient with placenta accreta

Peng

Zhang

2018

Medicine

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“…If complications occur despite efforts to prevent injury, the clinical manifestations would be abdominal pain, dyspnea, back pain, or shock 3) . However, it is difficult to detect these symptoms because the patient assumes a prone position under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis in addition to immediate surgical repair is necessary for this condition. While surgery has a higher mortality rate due to hemodynamic instability, endovascular surgery has better outcomes with regard to mortality and morbidity because of its minimal invasiveness 3) .…”

Section: Discussionmentioning

confidence: 99%

Aortic Injury during Transforaminal Lumbar Interbody Fusion

et al. 2017

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Aortic injury during transforaminal lumbar interbody fusion (TLIF) is a rare but severe complication. We experienced aortic injury during TLIF at L3–4 with a 59-year-old woman diagnosed with an adjacent segment disease at L3–4. Severe bleeding occurred during disc space expansion, and the blood pressure dropped to 60/40 mmHg. The patient’s vital sign stabilized after compression with gauze and Gelfoam in addition to blood transfusion. The patient was treated with endovascular repair using a percutaneous technique after intertransverse fusion at L3–4 was completed. She recovered and is being followed-up in the outpatient department.

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“…Iliac artery injury following lumbar discectomy could be treated by direct surgical repair of the damaged vessel,[ 7 ] a single balloon inflation,[ 8 ] insertion of a covered stent,[ 9 ] and coil embolization for a bleeding vessel. [ 10 ] In our case, we chose transarterial embolization with multiple metallic coils based on the fact that our patient's hemodynamics were progressively compromised.…”

Section: Discussionmentioning

confidence: 99%

“…However, vascular injury is occasionally reported. [ 1 2 3 4 5 6 7 ] Without prompt diagnosis, the prognosis is dismal, even fetal. [ 2 ] Here, we report a patient with right lower quadrant pain that was caused by internal iliac artery injury after lumbar discectomy mimicking appendicitis.…”

Section: Introductionmentioning

confidence: 99%

Vascular injury after lumbar discectomy mimicking appendicitis: Report of a case

2015

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Right lower quadrant pain after a lumbar discectomy is a rare condition. We report on a 29-year-old man who developed right lower quadrant pain 12 h after lumbar discectomy due to the formation and rupture of a right iliac artery pseudoaneurysm. The diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma. An emergency abdominal computed tomography confirmed a right iliac artery pseudoaneurysm rupture. We performed a transarterial embolization with multiple metallic coils in the aneurysm cavity and connected the proximal and distal right internal iliac artery because his hemodynamics became progressively unstable. In this article, in addition to presenting the clinical course of an unusual case, we also wanted to emphasize that patients with right lower quadrant pain could be presenting an early sign of pseudoaneurysm formation and rupture after a lumbar discectomy.

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Right Iliac Aortic Aneurysmal Hemorrhage as a Complication of Lumbar Discectomy

Cited by 5 publications

References 9 publications

Rupture of multiple pseudoaneurysms as a rare complication of common iliac artery balloon occlusion in a patient with placenta accreta

Rupture of multiple pseudoaneurysms as a rare complication of common iliac artery balloon occlusion in a patient with placenta accreta

Aortic Injury during Transforaminal Lumbar Interbody Fusion

Vascular injury after lumbar discectomy mimicking appendicitis: Report of a case

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