Combined Aorto-Iliac and Anterior Lumbar Spine Reconstruction: A Case Series

Abstract

Background: Treatment options for aortic-iliac pathology may include endovascular repair and open surgical repair. Treatment options for degenerative disc disease (DDD) are varied but commonly include anterior reconstruction. When both the aortic-iliac and spinal pathologies are significant and surgical intervention is indicated for each pathology, the opportunity exists for concurrent treatment of both the aortic-iliac pathology and DDD in the same operation. The purpose of this case series was to document the safety and feasibility of a surgical strategy whereby a combined elective reconstructive procedure was performed for aortic and anterior lumbar spinal pathologies.Methods: The case histories of 5 patients who were treated for both spinal and vascular pathology are presented. Surgical outcome measures included operative time, blood loss, length of stay, and complications. Spine-specific outcome measures included Oswestry Disability Index, Roland Morris Disability Questionnaire, and visual analogue scores (back and leg).Results: The spinal reconstructions performed included 1 L4-5 total disc replacement (TDR), 1 L4-5, L5-S1 anterior lumbar interbody fusion (ALIF), 1 L5-S1 ALIF, and 2 hybrid procedures (L4-5 TDR with L5-S1 ALIF). Vascular reconstructions included 4 aorto-bi-iliac bypass grafts and 1 aortic tube graft. The average operative time was 365 minutes (ranging between 330 and 510 minutes), the average blood loss was 1699 mL (range between 1160 and 2960 mL), and the average length of hospital stay was 14 days (range from 8 to 22 days). There were no in-hospital complications, and all patients experienced significant improvement in both back and leg pain. One patient developed kinking of the iliac limbs of the vascular graft 1 year postoperatively, which was managed with endovascular stenting of the graft.Conclusions: Aortic-iliac pathology and DDD are significant pathologies often treated in isolation. This study illustrates that, despite its complexity, highly trained individuals in a specialized setting can perform combined surgery to achieve a satisfactory outcome for the patient.Level of Evidence: Level IV evidence. Lumbar SpineKeywords: abdominal aortic aneurysm, total disc arthroplasty, anterior lumbar interbody fusion, aortic iliac occlusive disease, multidisciplinary approach by guest on July 5, 2020 http://ijssurgery.com/ Downloaded from Abbreviations: VAS, visual analogue score; ODI, Oswestry Disability Index; RMDQ, Roland Morris Disability Questionnaire.

Cutaneous manifestations of aortoiliac occlusive disease: two cases and review of the literature

“…[2] As far as the occlusive atherosclerotic process is chronic, it leads to development of collateral blood vessels supplying the affected extremities, hence the clinical tissue ischemia and the cutaneous injury features may occur in different interval and severity. [3,4] It has been reported that the coexistence of AIOD, abdominal aortic aneurysm, ischemic heart disease, and cerebrovascular disease carry a very poor prognosis. [5] Based on the morphology and the level of lesions, the Trans-Atlantic Inter-Society Consensus (TASC) guidelines classified aortoiliac atherosclerotic disease TASC II C and D types and the standard recommended treatment is bilateral surgical bypass of the femoral arteries.…”