Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Thrombosis of Left Common Iliac Artery Following Anterior Lumbar Interbody Fusion : Case Report and Review of Literatures

  • Kim, Jin-Sung (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Choi, Kyung-Chul (Department of Neurosurgery, Uijeongbu Emergency Medical Information Center) ;
  • Jung, Byung-Joo (Department of Neurosurgery, Wooridul Spine Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Spine Hospital)
  • Published : 2009.04.28
Download PDF
⟨ Previous Next ⟩

Abstract

We report on a case of thrombosis of the left common iliac artery following anterior lumbar interbody fusion (ALIF) of L4-5 in a 79-year-old man with no previous medical problems, including peripheral vascular disease. After completing the ALIF procedure, the surgeon could not feel the pulsation of the left dorsalis pedis artery, and the oxygen saturation ($SaO_2$) had fallen below 90% from pulse oxymetry on the left great toe. Thrombectomy was successfully performed after confirming the thrombus in the left common iliac artery using Computed Tomography (CT) angiography. Thrombosis of the common iliac artery is very rare following ALIF. However, delayed diagnosis can lead to disastrous outcome. Although elderly patients have no cardio-vascular disease or vessel calcification in pre-op evaluation, the possibility of a complication involving L4-5 should be considered.

Keywords

References

  1. Baker JK, Reardon PR, Reardon MJ, Heggeness MH : Vascular injury in anterior lumbar surgery. Spine 18 : 2227-2230, 1993 https://doi.org/10.1097/00007632-199311000-00014
  2. Brau SA : Mini-open approach to the spine for anterior lumbar interbody fusion : description of the procedure, results and complications. Spine J 2 : 216-223, 2002 https://doi.org/10.1016/S1529-9430(02)00184-5
  3. Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG : Left iliac artery thrombosis during anterior lumbar surgery. Ann Vasc Surg 18 : 48-51, 2004 https://doi.org/10.1007/s10016-003-0104-0
  4. Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG : Vascular injury during anterior lumbar surgery. Spine J 4 : 409-412, 2004 https://doi.org/10.1016/j.spinee.2003.12.003
  5. Carl AL, Kostuik J, Huckell CB, Abitbol JJ, Matsumoto M, Sieber A : Surgeon perceptions of the complications and value of threaded fusion cages as a spine fusion technique: results of a consensus survey. Spine J 3 : 356-359, 2003 https://doi.org/10.1016/S1529-9430(03)00062-7
  6. Chung SK, Lee SH, Lim SR, Kim DY, Jang JS, Nam KS, et al : Comparative study of laparoscopic L5-S1 fusion versus open mini-ALIF, with a minimum 2-year follow-up. Eur Spine J 12 : 613-617, 2003 https://doi.org/10.1007/s00586-003-0526-y
  7. Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L : The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine 20 : 1592-1599, 1995 https://doi.org/10.1097/00007632-199507150-00007
  8. Hackenberg L, Liljenqvist U, Halm H, Winkelmann W : Occlusion of the left common iliac artery and consecutive thromboembolism of the left popliteal artery following anterior lumbar interbody fusion. J Spinal Disord 14 : 365-368, 2001 https://doi.org/10.1097/00002517-200108000-00015
  9. Inamasu J, Guiot BH : Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir (Wien) 148 : 375-387, 2006 https://doi.org/10.1007/s00701-005-0669-1
  10. Khazim R, Boos N, Webb JK: Progressive thrombotic occlusion of the left common iliac artery after anterior lumbar interbody fusion. Eur Spine J 7 : 239-241, 1998 https://doi.org/10.1007/s005860050064
  11. Kulkarni SS, Lowery GL, Ross RE, Ravi Sankar K, Lykomitros V : Arterial complications following anterior lumbar interbody fusion : report of eight cases. Eur Spine J 12 : 48-54, 2003
  12. Marsicano J, Mirovsky Y, Remer S, Bloom N, Neuwirth M : Thrombotic occlusion of the left common iliac artery after an anterior retroperitoneal approach to the lumbar spine. Spine 19 : 357-359, 1994 https://doi.org/10.1097/00007632-199402000-00019
  13. Mayer HM : Comment to 'Arterial complications following anterior lumbar interbody fusion: report of eight cases', by S. S. Kulkarni et al. Eur Spine J 12 : 55-56, 2003
  14. Mayer HM : The ALIF concept. Eur Spine J 9 : S35-S43, 2000 https://doi.org/10.1007/PL00010020
  15. Oskouian RJ Jr, Johnson JP : Vascular complications in anterior thoracolumbar spinal reconstruction. J Neurosurg 96 : 1-5, 2002 https://doi.org/10.3171/jns.2002.96.1.0001
  16. Raskas DS, Delamarter RB : Occlusion of the left iliac artery after retroperitoneal exposure of the spine. Clin Orthop Relat Res 338 : 86-89, 1997 https://doi.org/10.1097/00003086-199705000-00012
  17. Sasso RC, Best NM, Mummaneni PV, Reilly TM, Hussain SM : Analysis of operative complications in a series of 471 anterior lumbar interbody fusion procedures. Spine 30 : 670-674, 2005 https://doi.org/10.1097/01.brs.0000155423.18218.75
  18. Tiusanen H, Seitsalo S, Osterman K, Soini J : Anterior interbody lumbar fusion in severe low back pain. Clin Orthop Relat Res 324 : 153-163, 1996 https://doi.org/10.1097/00003086-199603000-00018
  19. Watkins R : Anterior lumbar interbody fusion surgical complications. Clin Orthop Relat Res 284 : 47-53, 1992

Cited by

  1. The routine intra-operative use of pulse oximetry for monitoring can prevent severe thromboembolic complications in anterior surgery vol.20, pp.12, 2009, https://doi.org/10.1007/s00586-011-1900-9
  2. Pullout Analysis of a Lumbar Plate With Varying Screw Orientations: Experimental and Computational Analyses vol.37, pp.16, 2009, https://doi.org/10.1097/brs.0b013e318254155a
  3. Variations of the Iliolumbar and Ascending Lumbar Veins vol.25, pp.8, 2012, https://doi.org/10.1097/bsd.0b013e31823c0fa0
  4. A comparison of complication rate between anterior and lateral approaches to the lumbar spine vol.158, pp.1, 2009, https://doi.org/10.5507/bp.2012.079
  5. Brief intraoperative heparinization and blood loss in anterior lumbar spine surgery vol.23, pp.3, 2015, https://doi.org/10.3171/2014.12.spine14888