Vertebral Body Erosion by a Chronic Contained Rupture of Thoracoabdominal Aortic Aneurysm: Systematic Review and Spine Surgical Recommendations

Pesce, Alessandro; Armocida, Daniele; Petrella, Gianpaolo; Guerrini, Francesco; Pompucci, Angelo

doi:10.1016/j.wneu.2021.10.116

Cited by 2 publications

(11 citation statements)

References 62 publications

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“…Aortic aneurysms (defined as a dilatations of the vessel measuring 50% greater than the proximal normal segment 5 ) are frequent in daily practice, but the association of a CCR and VBE is very unusual as highlighted in a recent review of the literature where only 80 cases have been identified from 1962 to 2022. 6…”

Section: Discussionmentioning

confidence: 99%

“…Major risk factors are shared with atherosclerotic disease, particularly smoking and hypertension. 6…”

Section: Discussionmentioning

confidence: 99%

“…These aneurysms tend to have a very large diameter (about 7 cm) and are more frequently located in the infra-renal area, thus causing erosion mostly of the anterior wall of lumbar vertebrae. 6…”

Section: Discussionmentioning

confidence: 99%

“…22 Some authors report that EVAR should be avoided, because of the possible increased risk both of endoleak (in relation to lack of aortic wall) and infection (as the surgical debridement of tissues cannot be performed) 11 ; however, in a recent review, it emerged that the endovascular treatment was associated with good outcomes. 6…”

Section: Discussionmentioning

confidence: 99%

“…It is also necessary to point out that a combined vascular and neurosurgical procedure can be aggressive and time-consuming, with relatively high surgical risk, hence not routinely performed. 6…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Contained Chronic Rupture of Abdominal Aortic Aneurysm Associated With Vertebral Erosion: Pre- and Post-operative Findings on Computed Tomography and a Narrative Review

Parillo

Vaccarino

Zobel

et al. 2022

Vasc Endovascular Surg

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Contained chronic rupture of aortic aneurysm (CCR-AA) is a rare condition that can be associated with vertebral body erosion (VBE) and is often a diagnostic challenge; in fact, CCR-AAs are in general hemodynamically stable and the patients tend to present with a non-specific low-back pain syndrome secondary to vertebral involvement. Furthermore, the differential diagnosis of a retroperitoneal mass can be difficult on medical imaging. We discuss the case of a 79-years-old man, heavy smoker without history of cardiovascular diseases, admitted to the emergency department with signs of left lower limb ischemia. The patient was hemodynamically stable and the medical examination revealed a pulsatile abdominal mass. Doppler ultrasound showed the presence of aneurysmal dilatation of infra-renal abdominal aorta and chronic femoropopliteal occlusion on the left side. The subsequent computed tomography angiography (CTA) demonstrated a voluminous retroperitoneal mass continuous with the infra-renal aorta, which infiltrated the psoas muscles and caused vertebral bodies erosion of the anterior wall in L2, L3 and L4 suspected for CCR-AA or mycotic aortic aneurysm. Furthermore, the examination confirmed the occlusion of the peripheral arterial circulation of the left lower limb. The patient underwent a successful open replacement of the infra-renal abdominal aorta through aorto-aortic prosthetic graft insertion; the visualization during the surgical procedure of a posterior vessel wall opening in continuity with the eroded vertebral bodies associated with negative microbiological culture of the thrombotic material sample, led to the definitive diagnosis of CCR-AA. The post-operative CTA showed successful open vascular treatment. A bypass surgery of the left lower limb was then performed with positioning saphenous graft between femoral common artery and posterior tibial artery. The patient was finally discharged in good clinical conditions.

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Section: Discussionmentioning

confidence: 99%

“…Major risk factors are shared with atherosclerotic disease, particularly smoking and hypertension. 6…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%