Delayed presentation of aortic injury by pedicle screws: Report of two cases and review of the literature Stavros K. Kakkos, MD, MSc, PhD, Alexander.

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Presentation transcript:

Delayed presentation of aortic injury by pedicle screws: Report of two cases and review of the literature Stavros K. Kakkos, MD, MSc, PhD, Alexander D. Shepard, MD Journal of Vascular Surgery Volume 47, Issue 5, Pages 1074-1082 (May 2008) DOI: 10.1016/j.jvs.2007.11.005 Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 1 Patient 1. Chest radiograph demonstrates the lateral migration of one of the inferior transpedicular screws (black arrow) of the right lateral spinal fixation plate (white arrow) as well as focal paraspinal soft tissue bulge in this region. Two spinal rods (white arrowheads) and an intervertebral spinal cage (black arrowhead) are also shown. Journal of Vascular Surgery 2008 47, 1074-1082DOI: (10.1016/j.jvs.2007.11.005) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 2 Patient 1. A, A computed tomography chest scan shows the side-plate screw (black arrow) protruding laterally from the side-plate associated with a focal contrast collection along the medial aspect of the distal descending thoracic aorta compatible with a pseudoaneurysm. B, Left lateral protrusion of the superior-most side-plate screw (white arrow) projecting to the medial margin of the thoracic aorta. Journal of Vascular Surgery 2008 47, 1074-1082DOI: (10.1016/j.jvs.2007.11.005) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 3 Patient 1. A, Thoracic aortography shows a 2.0- × 1.8-cm pseudoaneurysm lumen (black arrow) arising from the medial aspect of the descending thoracic aorta at the level of the inferior screw (white arrow). B, Image shows a screw abutting the medial wall of the proximal descending thoracic aorta above the cage at the level of T6 with full-thickness wall penetration and associated small extravasation of contrast (white arrow). Journal of Vascular Surgery 2008 47, 1074-1082DOI: (10.1016/j.jvs.2007.11.005) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 4 Patient 1. A, Operative photo shows screw-tip perforation of the right (medial) wall of the thoracic aorta at the T6 level through a transverse aortotomy. Four 3F Fogarty catheters are used to control backbleeding from two pairs of intercostal arteries in the occluded segment of aorta. B, Operative photo shows pseudoaneurysm cavity at the T-10 level, with the screw pointing towards the aortic defect. Again, 3F Fogarty catheters were used to occlude backbleeding intercostals. Journal of Vascular Surgery 2008 47, 1074-1082DOI: (10.1016/j.jvs.2007.11.005) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 5 Patient 1. Intraoperative photo shows the proximal (T-6 level) aortotomy closure with interrupted 3-0 polypropylene suture (white arrow) and the distal (T-10 level) aortotomy patch closure with a running 4-0 polypropylene suture (black arrow). Journal of Vascular Surgery 2008 47, 1074-1082DOI: (10.1016/j.jvs.2007.11.005) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 6 Patient 2. A, Computed tomography chest scan demonstrates a screw penetrating the posterior wall of the aorta without evidence of associated pseudoaneurysm or dissection. B, Computed tomography angiography. Journal of Vascular Surgery 2008 47, 1074-1082DOI: (10.1016/j.jvs.2007.11.005) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 7 Patient 2. Operative photo shows the descending thoracic aorta retracted medially to expose the screw tip and perforation site (white arrow) in the posterior aortic wall. Journal of Vascular Surgery 2008 47, 1074-1082DOI: (10.1016/j.jvs.2007.11.005) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions