LOMBER DİSK CERRAHİSİNİN KABUSU AORT YARALANMASI: OLGU SUNUMU

Lomber intervertebral disk cerrahisinde vasküler yaralanmalar nadir olmakla birlikte bazı komplikasyonları ölümcül olabilmektedir. 51 yaşında erkek hasta prone pozisyonunda posterior yaklaşımla L3-L4 intervebtebral disk cerrahisi sırasında arteryel vasıfta kanama görülmesi üzerine tarafımıza konsülte edildi. Abondan olan kanama görüldü ve acil laparotomi yapıldı. Retroperitonda hematom izlendi ve ekspojur sağlanarak abdominal aortaya ulaşıldı. Abdominal aortanın posterior yüzeyinde kanama görüldü. Kompresyonla kanama kontrol altına alındı ve hemodinamik stabilite sağlandı. Uygun heparinizasyon sonrası vasküer klempler konuldu. Aortatomi yapılarak posterior duvardaki laserasyon primer onarıldı. Hasta şifa ile taburcu edildi. Endovasküler yöntemlerin gelişmesi ve kolay ulaşımıgünümüzde vasküler komplikasyonlarda sıkça tercih edilen yöntem olmuştur. Hemodinamisi anstabil olan hastalarda ise açık cerrahinin zaman kaybetmedenuygulanması hayat kurtarıcı olacaktır.

AORTIC INJURY WHICH IS A NIGHTMARE OF A LUMBAR DISC SURGERY: A CASE REPORT

Vascular injuries rarely occur in lumbar intervertebral disc surgery but it may be fatal. 51-year-old male patient was operated for L3-L4 intervertebral disc hernia via posterior approach. After arterial pulsatile hemorrhage was determined, case was referred to our clinic perioperatively for evaluation. Massive hemorrhage was seen and we immediately put some guages on the field and turn the patient in supine position and emergency laparotomy was performed. Retroperitoneal hematoma was observed and abdominal aorta was reached by providing exposures. Bleeding occurred on the posterior surface of the abdominal aorta. Bleeding was controlled by compression and hemodynamic stability was achieved. Vascular clamps were placed after applying appropriate heparine. Laceration of posterior wall of aortotomy was repaired. After proper heamostasis, operation terminated without any complications. Patient admitted to intensive care unit and after follow up the patient was discharged without any complications. Today, endovascular systems preferred and successful approaches were performed in some cases. But in hemodynamically unstable patients, open surgery still utmost preferred as a lifesaving procedure time

PDF

___

1. Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA. Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg. 2002;24:189–95.
2. Liu Y. Analysis of vascular injury in lumbar spine surgery. Pak J Med Sci 2012;28(5):791-794.
3. Luan JY, Li X. A misdiagnosed iliac pseudoaneurysm complicated lumbar disc surgery performed 13 years ago. Spine (Phila Pa 1976) 2012;37:E1594–7.
4. Erkut B, Unlu Y, Kaygin MA, Colak A, Erdem AF. Iatrogenic vascular injury during to lumbar disc surgery. Acta Neurochirurgica. 2007;149(5):511-515.
5. Szolar DH, Preidler KW, Steiner H, Riepl T, Flaschka G, Stiskal M, et al. Vascular complications in lumbar disk surgery: report of four cases. Neuroradiology 1996;38:521-525.
6. J. Inamasu and B. H. Guiot. Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir (Wien). 2006 Apr;148(4):375-87
7. Hong Sung Jung, Dae Jung Kim, Hyo Shin Kim, Ho Kyun Lee, Soo Jin Na Choi, and Sang Young Chung. Vascular Complications Related to Posterior Lumbar Disc Surgery.Vascular Specialist İnternational Vol. 33, No. 4, December 2017
8. Bolesta MJ. Vascular injury during lumbar diskectomy associated with peridiskal fibrosis: case report and literature review. J Spinal Disord 1995;8:224-227
9. Bingol H, Cingoz F, Yılmaz AT, Yasar M. Vascular complications related lumbar disc surgery. J Neurosurg. 2004; 100:249-53.
10. van Zitteren M, Fan B, Lohle PN, de Nie JC, de Waal Malefijt J, Vriens PW, et al. A shift toward endovascular repair for vascular complications in lumbar disc surgery during the last decade. Ann Vasc Surg 2013;27:810- 819.
11. Döşoğlu M, İş M, Pehlivan M, Yıldız KH. Nightmare of lumbar disc surgery: iliac artery injury. Clinical Neurology and Neurosurgery 2006; 108: 174-177.
12. Düz B, Kaplan M, Günay C, Üstünsöz B, Uğurel MŞ. Iliocaval Arteriovenous Fistula Following Lumbar Disc Surgery: Endovascular Treatment with a Stent-Graft. Turkish Neurosurgery 2008; 18; 245-248.
13. Franzini M, Altana P, AnnessiV, LodiniV. Iatrogenic vascular injuries following lumbar disc surgery. Case report and review of the literature. J Cardiovascular Surg (Torino) 1987; 28
14. Biasi GM. Aortocaval fistula: a challenge for endovascular management. J Endovasc Surg 1999; 6: 378