Chang Yong-Shun, Guyer Richard D, Ohnmeiss Donna D, Moore Sandra
Texas Health Research Institute and Texas Back Institute, Plano 75093, USA.
Spine (Phila Pa 1976). 2003 Aug 15;28(16):E316-9. doi: 10.1097/01.BRS.0000083320.77058.5A.
This is a case report of a left common iliac artery occlusion identified as an intraoperative complication during a planned (combined anterior interbody and posterior fusion) 360 degrees spinal fusion.
The purpose of this report was to document the occurrence of this rare complication during a planned 360 degrees fusion and to increase the awareness of this potential intraoperative vascular complication.
Several cases of left iliac artery occlusion after anterior spinal surgery have been reported, but there has been no reported case of intraoperative iliac artery occlusion identified during a planned 360 degrees spinal fusion.
The patient was a 46-year-old woman with chronic low and mid back pain and left leg pain for several years. She was a 2-pack-a-day cigarette smoker for 30 years. She was diagnosed with internal disc disruption at L3-L4 and L4-L5, unresponsive to nonoperative treatment, and was scheduled for a 360 degrees spinal fusion. During the anterior procedure, the left iliac vessels were retracted with a Wiley retractor during the discectomy and fusion. It was noted that there was no pulse in the left common iliac artery as the anterior procedure neared completion. Intraoperative Doppler showed the left iliac artery was occluded, and a left iliac endarterectomy and thrombectomy were performed immediately.
A significant occlusive plaque was separated distally and transected in a smooth fashion, and fresh thrombus was also removed. The procedure was successfully accomplished without any further complication with excellent restoration of arterial blood flow to the left lower extremity. Doppler study showed good triphasic flow in the iliac artery and all its branches. Because of the arterial repair, the posterior portion of the surgery was not undertaken at that time and was performed 2 weeks later.
Early recognition and appropriate treatment can prevent serious sequelae. Great care and observation should be given to the patients before surgery, intraoperatively, as well as after surgery.
这是一例关于在计划进行的（前路椎间融合联合后路融合）360度脊柱融合手术中，左髂总动脉闭塞被识别为术中并发症的病例报告。
本报告的目的是记录在计划的360度融合手术中这种罕见并发症的发生情况，并提高对这种潜在术中血管并发症的认识。
已有数例脊柱前路手术后左髂动脉闭塞的病例报道，但尚无在计划的360度脊柱融合手术中识别出术中髂动脉闭塞的病例报道。
患者为一名46岁女性，慢性下背部和中背部疼痛及左腿疼痛数年。她有30年每天吸两包烟的吸烟史。她被诊断为L3 - L4和L4 - L5椎间盘内紊乱，非手术治疗无效，计划进行360度脊柱融合手术。在前路手术过程中，在椎间盘切除和融合时用威利牵开器牵拉左髂血管。在前路手术接近完成时，注意到左髂总动脉无搏动。术中多普勒检查显示左髂动脉闭塞，立即进行了左髂动脉内膜切除术和血栓切除术。
一个显著的闭塞斑块在远端被分离并顺利横断，新鲜血栓也被清除。手术成功完成，未出现任何进一步并发症，左下肢动脉血流恢复良好。多普勒检查显示髂动脉及其所有分支有良好的三相血流。由于进行了动脉修复，当时未进行手术的后部部分，并在两周后进行。
早期识别和适当治疗可预防严重后遗症。术前、术中和术后都应给予患者密切关注和观察。
