Vascular Injury in Thoracolumbar Spinal Surgeries and Role of Angiography in Early Diagnosis and Management

Abstract

The vascular injuries during thoracolumbar spinal surgeries need immediate and aggressive treatment. In arterial injuries, we can prevent serious consequences by subjecting the patient to an angiography as early as possible followed by a therapeutic embolization. In contrast, for venous injuries if hemostasis has been confirmed, then an immediate intervention may not be always required.

Embolisation for Vascular Injuries Complicating Elective Orthopaedic Surgery

“…In addition, NBCA can be used in patients with clotting pathologies. 9,11 In our practice and the present study, NBCA was the preferred embolic agent because we consider it the most appropriate for controlled embolisation and permanent, complete occlusion of the bleeding vessels. If administered in low doses, sandwiched with glucosate under fluoroscopic control, post-embolisation complications are rare; if more volume of NBCA is administered at a time, it may reflux and occlude normal vessels.…”

“…1 The risk after revision-knee arthroplasty is twice as high because of encasement of the poplitaeal vessels by dense scar tissue in the poplitaeal fossa. 2 The incidence of vascular injuries in spinal surgery has been <0.05%, 6,7,9 most commonly associated with L4eL5 lumbar discectomy. 6,9,37 In the present series, vascular injuries were more common in hip compared with knee arthroplasty.…”

“…2 The incidence of vascular injuries in spinal surgery has been <0.05%, 6,7,9 most commonly associated with L4eL5 lumbar discectomy. 6,9,37 In the present series, vascular injuries were more common in hip compared with knee arthroplasty. The most common injured vessel was the superior glutaeal artery, followed by the profunda femoris artery; in contrast to the literature, 8,10 iatrogenic vascular injuries of the genicular arteries were not rare.…”

“…Angiography provides for superior image quality and detection of active bleeding even from small blood vessels, 1,3,9,18e20,28,35,36 and can be combined with endovascular procedures once bleeding is diagnosed. 9 Magnetic resonance angiography is usually not applicable in joint replacement operations because of the artefacts caused by the prostheses. Indications for embolisation are significant blood loss, coagulation defects, failure of surgical attempts by experienced personnel to control bleeding, recurrent bleeding, and bleeding sources at small branch vessels or non-critical axial vessels that are not immediately obvious and are amenable to embolisation.…”

Pseudoaneurysm of a high-division anterior tibial artery following primary TKA

“…When a noninvasive test cannot clarify the diagnosis, however, angiography may be required [16]. Angiography can show the exact location of the pseudoaneurysm and vascular malformation, and it can be used for therapeutic purposes by stopping the bleeding once discovered [17]. Computed tomography and magnetic resonance angiography are not usually considered for diagnosis of artifacts caused by the prostheses, while magnetic resonance imaging can be used to identify an aberrant ATA preoperatively [4].…”