Incidence of Vascular Complications Arising from Anterior Spinal Surgery in the Thoraco-Lumbar Spine

STUDY DESIGN: Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high. PURPOSE: The aim of this study was to give a general overview and identify the incidence of vascular complications. OVERVIEW OF LITERATURE: There is limited literature describing the overall incidence and complications of anterior spinal surgery. METHODS: A retrospective review of a prospective database of 1,262 consecutive patients with anterior surgery over a twelve-year period. RESULTS: In our study, 1.58% (n=20) of patients suffered complications. Injury to a major vessel was encountered in 14 (1.11%) cases, of which nine involved an injury to the common iliac vein. In six cases, the original procedure was abandoned due to a life-threatening vascular injury (n=3) and unfavourable anatomy (n=3). CONCLUSIONS: The incidence of vascular and other complications in our study was relatively low. Nevertheless, the potential for devastating long-term sequelae as a result of complications remains high. A thorough knowledge and awareness of normal and abnormal anatomy should be gained before attempting such a procedure, and a vascular surgical assistance especially should be readily accessible. We believe use of access surgeons is mandatory in cases with difficult or aberrant anatomy.

Left Iliac Vein Compressions and Venous Hemodynamic Changes

PURPOSE: Left iliac vein compression is a risk factor for deep vein thrombosis (DVT) and often can be symptomatic. We wanted to know the incidence of left iliac vein compressions in the general population and the relationship between iliac vein compression and outflow fraction of the lower extremities. METHODS: 1,523 cases examined with abdomen - pelvis CT were included in this study. Left iliac vein compression was calculated as the diameter of left common iliac vein at the site of maximal compression divided by the diameter of the uncompressed caudal common iliac vein. These cases were divided into 4 groups by the degree of iliac vein compression. In addition, left lower extremity venous outflow fractions in 106 patients with abdomen - pelvis CT images were recorded and analyzed. RESULTS: The number and mean age of each group (group 1, 2, 3 and 4) were 351 (23%) & 62.3+/-13.4, 426 (28%) & 57.7+/-16.1, 529 (35%) & 50.1+/-20.4 and 217 (14%) & 40.7+/-22.9, respectively. While the age of patients was decreasing, the occurrence of left iliac vein compression increased (P<0.01). The mean left low extremity venous outflow fractions of each group (group 1, 2, 3 and 4) was 27.9+/-6.9%, 26.9+/-6.4%, 25.9+/-6.7% and 19.1+/-6.6%, respectively. The mean outflow fraction of group 4 was significantly lower than that of other groups (P<0.01). There was a tendency that the more left iliac vein compression increased, the more outflow fraction decreased (P=0.011). CONCLUSION: In 14% of 1,523 cases, there were severe left iliac vein compressions, more than 75% diameter, and the mean outflow fraction of that was lower than in others. Further study is needed to realize the relationship between left iliac vein compression and DVT.

Interventional Therapy for Left Iliac Vein Compression Syndrome / 中国微创外科杂志

Objective To evaluate the efficacy and safety of interventional therapy for left iliac vein compression syndrome (LICS). Methods A total of 27 patients with LICS that were diagnosed by colour Doppler or venography,were included in this study. Among the cases,the disease course was shorter than 3 weeks in 13 patients,who presented with acute iliac-femoral vein thrombosis; in the other 14 patients,the disease course was longer than 3 weeks,showing the symptoms of chronic venous thrombosis. Venous puncture was performed via the contralateral femoral vein in 13 cases,and through the ipsilateral popliteal vein in 14. Venous filter was placed in 11 cases before thrombolysis,while in the other 16 cases,no filter was used. All of the patients received catheter-directed thrombolysis,afterwards,7 of them underwent percutaneous transluminal angioplasty,and the other 20 received angioplasty plus stent placement. Results In the 13 patients,who received venous puncture via the contralateral femoral approach,the guide wire could advance through the stenosis successfully in 8 patients but failed in 5. Ipsilateral popliteal vein puncture were then employed and succeeded in all the patients. Ipsilateral popliteal puncture were performed successfully in 14 patients. In 11 patients,inferior vena cava filter was placed before the procedure. In this series,the thrombolysis time was (85?16) h with a dose of (3000?320) thousand units urokinase. The thrombosis was dissolved completely in 13 acute patients and partial dissolution was attained in 14 patients in whom blood flow signal were detected color Doppler. After the operation,venogram showed complete patent iliac veins in all of the 27 cases. The patients were followed up for 6 to 26 months (mean,11 months). During the period,19 patients obtained patent iliac-femoral vein with the symptoms disappeared; 8 patients met the standard of improvement. Conclusions Interventional technique can be the first-line treatment for left iliac vein compression syndrome because of its favorable result and minimal invasion.