Vascular injury during anterior exposure of the spine

Hamdan, Allen D.; Malek, Janet; Schermerhorn, Marc L.; Aulivola, Bernadette; Blattman, Seth; Pomposelli, Frank B.

doi:10.1016/j.jvs.2008.04.028

Cited by 112 publications

(83 citation statements)

References 11 publications

(19 reference statements)

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“…Hamdan et al reported on 408 anterior exposures with a two percent rate of major vascular injuries. 1 The authors found that most injuries occurred during exposure, however, in our series all major vascular injuries occurred during the instrumentation portion of the procedure. Also, our preferred incision is transverse, while the Hamdan group prefers the vertical midline approach.…”

Section: Discussionmentioning

confidence: 50%

“…Hamdan et al recently reported an 11% incidence of major vascular injury in 480 patients undergoing spine exposure. 1 Vascular surgeons often are involved as "exposure surgeons" during these cases due to their unique skills in dealing with retroperitoneal structures, including the abdominal aorta and iliac vessels. We have explored our extensive experience with the two-team approach to anterior spine surgery, analyzed our injury pattern, and argue that this procedure provides ample opportunity for the general surgery and vascular surgery residents to increase their open vascular surgery experience.…”

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confidence: 99%

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The role of the vascular surgeon in anterior retroperitoneal spine exposure: Preservation of open surgical training

Chiriano

Abou-Zamzam

Urayeneza

et al. 2009

Journal of Vascular Surgery

113

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Vascular expertise is important in anterior retroperitoneal lumbar spine exposure. Minor venous injuries frequently occur during exposure and instrumentation. Significant vascular injuries, while rare, occur during instrumentation, therefore the vascular surgeon should remain present throughout the entire procedure. The vascular manipulations required during exposure of the L4-5 disc offer an excellent opportunity for open vascular surgical experience. Vascular surgeon involvement in these cases allows for prompt repair of vascular injuries and provides opportunities for the vascular surgery resident to augment his/her open surgical training.

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Section: Discussionmentioning

confidence: 50%

mentioning

confidence: 99%

The role of the vascular surgeon in anterior retroperitoneal spine exposure: Preservation of open surgical training

Chiriano

Abou-Zamzam

Urayeneza

et al. 2009

Journal of Vascular Surgery

113

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“…Many studies similarly report a significantly higher blood loss at the L4-5 level compared with L5-S1. 6,18,19,21 Exposure at L4-5 requires mobilization of the great vessels, which can lead to inadvertent vascular injuries; in particular, these include left common iliac vein laceration and avulsion of the iliolumbar vein from the common iliac vein. 7 Exposure of the L5-S1 level is usually performed distal to the aortic and vena cava bifurcations.…”

Section: Discussionmentioning

confidence: 99%

Brief intraoperative heparinization and blood loss in anterior lumbar spine surgery

Sim

Claydon

Parker

et al. 2015

SPI

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OBJECT The anterior approach to the lumbar spine may be associated with iliac artery thrombosis. Intraoperative heparin can be administered to prevent thrombosis; however, there is a concern that this will increase the procedural blood loss. The aim of this study was to examine whether intraoperative heparin can be administered without increasing blood loss in anterior lumbar spine surgery. METHODS A prospective study of consecutive anterior approaches for lumbar spine surgery was performed between January 2009 and June 2014 by a single vascular surgeon and a single spine surgeon. Patients underwent an anterior lumbar interbody fusion (ALIF) at L4–5 and/or L5–S1, a total disc replacement (TDR) at L4–5 and/or L5–S1, or a hybrid procedure with a TDR at L4–5 and an ALIF at L5–S1. Heparin was administered intravenously when arterial flow to the lower limbs was interrupted during the procedure. Heparin was usually reversed on removal of the causative retraction. RESULTS The cohort consisted of 188 patients with a mean age of 41.7 years; 96 (51.1%) were male. Eighty-four patients (44.7%) had an ALIF, 57 (30.3%) had a TDR, and 47 (25.0%) had a hybrid operation with a TDR at L4–5 and an ALIF at L5–S1. One hundred thirty-four patients (71.3%) underwent a single-level procedure (26.9% L4–5 and 73.1% L5–S1) and 54 (28.7%) underwent a 2-level procedure (L4–5 and L5–S1). Seventy-two patients (38.3%) received heparinization intraoperatively. Heparin was predominantly administered during hybrid operations (68.1%), 2-level procedures (70.4%), and procedures involving the L4–5 level (80.6%). There were no intraoperative ischemic vascular complications reported in this series. There was 1 postoperative deep venous thrombosis. The overall mean estimated blood loss (EBL) for the heparin group (389.7 ml) was significantly higher than for the nonheparin group (160.5 ml) (p < 0.0001). However, when all variables were analyzed with multiple linear regression, only the prosthesis used and level treated were found to be significant in blood loss (p < 0.05). The highest blood loss occurred in hybrid procedures (448.1 ml), followed by TDR (302.5 ml) and ALIF (99.7 ml). There were statistically significant differences between the EBL during ALIF compared with TDR and hybrid (p < 0.0001), but not between TDR and hybrid. The L4–5 level was associated with significantly higher blood loss (384.9 ml) compared with L5–S1 (111.4 ml) (p < 0.0001). CONCLUSIONS During an anterior exposure for lumbar spine surgery, the administration of heparin does not significantly increase blood loss. The prosthesis used and level treated were found to significantly increase blood loss, with TDR and the L4–5 level having greater blood loss compared with ALIF and L5–S1, respectively. Heparin can be administered safely to help prevent thrombotic intraoperative vascular complications without increasing blood loss.

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“…com.] during those surgical procedures that require a medial mobilization of the CIA, such as the exposure of the L4-5 spinal level (Hamdan et al, 2008). The origin of the ILA from the main stem of the IIA (Level C of origin) was in 52.5% in our study, comparable to the results of Heye (61%) and Naguib et al (50%), but consistently lower than the 96.3% of occurrence communicated by Chen et al and higher than the percent given by Bleich et al (28.3%) (Chen et al, 1999;Heye, 2006;Bleich et al, 2007;Naguib et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

The iliolumbar artery—Anatomic considerations and details on the common iliac artery trifurcation

et al. 2009

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The iliolumbar artery (ILA) of Haller is the largest nutrient pedicle of the ilium and its detailed knowledge is important for various surgical procedures that approach the lumbosacral junction, the L4/L5 disk space, the sacroiliac joint, the iliac and psoas muscles, or the lumbar spine. Also the ILA is relevant for various techniques of embolization. We aimed to evaluate the anatomic and topographic features of the ILA, by dissection on 30 human adult pelvic halves and on 50 angiograms. ILA was a constant presence and it emerged at Level A (from the common iliac artery (CIA), 8.75%), Level B (from the CIA bifurcation, 2.5%), Level C (from the internal iliac artery (IIA), 52.5%), Level D (from the IIA bifurcation, 3.75%), and Level E (from the posterior trunk of the IIA, 32.5%). Level B of origin of the ILA corresponds to a trifurcated CIA (morphology previously unreported), while Level D corresponds to a trifurcated IIA. A higher origin of the ILA corresponds to a more transversal course of it. A descending lumbar branch that leaves the iliac arterial system independently to enter the psoas major muscle, as seen in 48% of cases, may be misdiagnosed as ILA. Surgical interventions in the lumbar, sacral, and pelvic regions must take into account the variable origins of the ILA from the iliac system that can modify the expected topographical relations and may lead to undesired hemorrhagic accidents.

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Vascular injury during anterior exposure of the spine

Cited by 112 publications

References 11 publications

The role of the vascular surgeon in anterior retroperitoneal spine exposure: Preservation of open surgical training

The role of the vascular surgeon in anterior retroperitoneal spine exposure: Preservation of open surgical training

Brief intraoperative heparinization and blood loss in anterior lumbar spine surgery

The iliolumbar artery—Anatomic considerations and details on the common iliac artery trifurcation

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