Review of Vascular Anterior Exposure for Anterior Lumbar Interbody Fusion

Abstract

that this technology is associated with quicker procedure time and reduced contrast dose and radiation exposure. The purpose of this study was to determine whether these effects have any relevance regarding clinical outcomes.Methods: Fifty-five consecutive patients who underwent EVAR using conventional two-dimensional fluoroscopy were compared with 74 consecutive patients who underwent EVAR using 3D-IF. Complex EVARs, including thoracic, fenestrated, branched, and emergency procedures, were excluded. Fluoroscopy time, radiation dose, contrast volume, preoperative and postoperative creatinine, presence of endoleak, and length of stay were recorded.Results: 3D-IF was associated with a reduction in fluoroscopy time (21.2 minutes [18.2-31.4] vs 30.0 minutes [23.8-40.8]; P < .0001), administration of contrast volume (100 mL vs 150 mL ; P < .0001), and skin dose radiation (781.5 mGy vs 1235 mGy [933.5-1987]; P ¼ .0006). This was associated with a 40% reduction in postprocedure renal dysfunction (28.4% vs 50.9%) and contrast-induced nephropathy (5.4% vs 9.1%). There were more graft-related complications in the two-dimensional group, including type I and III endoleaks (9.1% vs 1.4%; P ¼ .04). Length of stay, a surrogate marker of postoperative morbidity, was lower in the 3D group (3 days [2-5] vs 4 days [3-7]; P ¼ .0003).Conclusions: We have demonstrated that the procedural benefits of 3D-IF (reduced fluoroscopy time, contrast volume, and skin dose radiation) are associated with a reduction in postoperative complications, including contrast-induced nephropathy and clinically significant endoleaks. It is likely that such benefits are even more pronounced in complex endovascular procedures such as fenestrated FEVAR.Objective: This retrospective review evaluated and reviewed the vascular exposures performed at a tertiary institution from January 2010 to April 2015. This allowed us to determine the factors that affect patient outcome.Methods: The 50-month review was based on the Australasian Vascular Audit database maintained by the unit vascular surgeons. The anterior lumbar interbody fusion (ALIF) exposure is a modification of the approach described by Brau, with a median vertical incision and a left-sided preperitoneal dissection for L4-L5 exposure and a right-sided preperitoneal dissection for L5-S1 exposure. Preoperative assessment included an assessment by the vascular surgeon and spinal surgeon. Deep vein thrombosis (DVT) prophylaxis was commenced intraoperatively and continued until discharge. Minor vessel injury requiring a single lateral suture, major vessel injury requiring suture ligation or reconstruction, and failed exposure were documented. Postoperative complications, such as DVT, pulmonary embolism, wound complication, and retrograde ejaculation in men, were recorded.Results: The vascular surgeons on the unit performed ALIF exposure in 203 patients, of whom there were 110 men (55.2%) and 93 women (45.8%). The mean body mass index was 30.8 kg/m 2 . Minor vessel injuries occurred in 11 (5.5%) and major injur...