Angiographic Findings in Arteriovenous Fistulas Following Lumbar Disk Surgery

Mh, Schrieber; Fj, Wolma; Lb, Morettin

doi:10.2214/ajr.101.4.957

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…16 Abdominal distention is due to an expanding retroperitoneal haematoma and/or paralytic ileus may not be relied upon, as it was found in less than 20% of cases. 28,33,34 History of previous disc or abdominal operations leading to adhesions between the retroperitoneal vessels and vertebral bodies. 1,2,22 Disruption or degeneration of the anterior annulus fibrosus and anterior longitudinal ligament or peridiscal fibrosis, both associated with chronic disc pathology 3,23,24 Inappropriately deep intrusion of the``pituary rongeur'', which is however required in the presence of advanced disc disease.…”

Section: Presentationmentioning

confidence: 99%

“…34 Angiography assisted in making the diagnosis and localized the lesion in 65 stable patients with AVF and/or pseudoaneurysm. 33,42 In one unstable patient angiography plus embolisation of superior rectal artery laceration was performed. 10,43 Computed tomography (CT scan), performed in only 17 patients, was diagnostic in one case of delayed AVF, where angiography was not performed.…”

Section: Diagnosismentioning

confidence: 99%

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Vascular Injury Complicating Lumbar Disc Surgery. A Systematic Review

Papadoulas¹,

Konstantinou²,

Kourea³

et al. 2002

European Journal of Vascular and Endovascular Surgery

244

240

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Section: Presentationmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Vascular Injury Complicating Lumbar Disc Surgery. A Systematic Review

Papadoulas¹,

Konstantinou²,

Kourea³

et al. 2002

European Journal of Vascular and Endovascular Surgery

244

240

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“…Крім того, очікується, що витік крові з ушкоджених судин відбудеться в напрямку найменшого опору в заочеревинний простір або з артерії у вену у випадку АВФ [30]. Здуття живота, спричинене заочеревинною гематомою та/або парезом кишківника, не є патогномонічним симптомом, оскільки спостерігається менш ніж у 20% випадків [49][50][51].…”

Section: ушкодження магістральних судинunclassified

Vascular injury during lumbar discectomy: risk factors, diagnosis, methods of surgical correction, features of anaesthetic management and intensive care

Nekhlopochyn,

Pylypenko,

Dubrov

2023

Ukr Neurosurg J

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One of the priority tasks in neurosurgery is to reduce the frequency of postoperative complications and mortality. Lumbar discectomy is the most frequently performed intervention in spinal neurosurgery and it is a fairly safe procedure. One of the possible intraoperative surgical complications, that threatens the patient’s life is vascular injury. The first clinical case of damage to the large vessels during discectomy was described in 1945. It is believed that the frequency of this complication is 1‒5 cases per 10,000 surgical interventions, but the literature notes that these figures may be significantly underestimated. Some authors indicate that the frequency of this complication, despite the development of surgical techniques over the past 50 years, has not significantly decreased, so it is important for surgeons to be informed and alert about the possibility of such a problem. Among the factors that significantly increase the risk of vascular damage congenital, acquired and technical are determined. Variability of clinical symptoms of damage to lagre vessels is due to different localization of injury, type (arterial, venous or combined) and scale of vascular disaster. For each level of surgical intervention, the "most typical" vessel damage is identified. Vascular injury during discectomy can occur according to three clinical and pathomorphological scenarios: manifestation of vessel rupture symptoms, arteriovenous fistula or a pseudoaneurysm formation. According to different authors, the frequency of these findings varies significantly. This review examines the symptoms of possible variants of vascular damage development during discectomy and describes the characteristics of surgical correction methods. Along with clarifying the location and variant of vascular damage, the critical thing is assessing the amount of blood loss and the rate of ongoing bleeding. In the case of suspected massive bleeding, the paramount importance is the involvement of additional medical personnel for the surgical haemostasis and providing sufficient blood for haemotransfusions. In case of a vascular accident, the key requirement for adequate anaesthetic management is the maintenance of permissive arterial hypotension until the moment of surgical haemostasis. Targeted treatment of haemorrhagic shock in case of damage to large vessels consists of rapid haemostatic resuscitation including blood components and products in a balanced 1:1:1 ratio, such as plasma, red blood cells, fresh frozen plasma, platelets, and coagulation factors. In Ukraine, obtaining a sufficient amount of blood components and products (according to the protocol of massive haemotransfusion) in case of unpredicted blood loss is a difficult task, therefore, in the absence of certain components or blood products, whole blood can be used as an alternative. The number and severity of complications and outcomes primarily depend on the efficiency and timeliness of blood transfusions, along with the speed of surgical arrest of bleeding. This publication describes in detail the main points of management of patients with massive bleeding according to modern international standards and Ukraine regulatory documents.

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“…The first case of injury to major retroperitoneal vessels during lumbar surgery was reported in 1945 [1] and extensive work was published in the 1950s to 1970s [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Since then, there have been numerous reports of single or multiple cases of lesions of the abdominal aorta, inferior vena cava, common iliac arteries and/or common iliac veins, and internal or external iliac artery; the reported prevalence ranging from 0.03% to 0.17% [21][22][23][24][25][26][27] (Table 1).…”

Section: Introductionmentioning

confidence: 99%