Vulev Ivan, Klepanec Andrej, Madaric Juraj, Tomka Jan, Sefranek Vladimir
Department of Diagnostic and Interventional Radiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia.
Ann Vasc Surg. 2011 Nov;25(8):1140.e13-6. doi: 10.1016/j.avsg.2011.04.007. Epub 2011 Aug 11.
Vascular complications after lumbar laminectomy are rare, but are potentially life-threatening. A 59-year-old man presented with progressive and worsening abdominal pain over several weeks. Multidetector computed tomography angiography revealed a large aorto-ostial left renal artery pseudoaneurysm 3 years after lumbar laminectomy. The pseudoaneurysm was successfully treated with a combination of various endovascular techniques ("jailed" microcatheter technique, stent-graft implantation, thrombin injection, balloon remodeling technique, Onyx application), with preserved patency of the left renal artery and pseudoaneurysm exclusion on 6-month follow-up multidetector computed tomography angiography. The size and location of this pseudoaneurysm and the combination of different techniques for endovascular treatment provides an update on current endovascular technology. Combination of different endovascular techniques can be a safe and feasible alternative for the treatment of complicated iatrogenic postlaminectomy vascular injuries and renal artery pseudoaneurysms.
腰椎椎板切除术后的血管并发症很少见，但可能危及生命。一名59岁男性在数周内出现进行性加重的腹痛。多层螺旋计算机断层扫描血管造影显示，腰椎椎板切除术后3年出现一个巨大的主动脉-左肾动脉开口处假性动脉瘤。采用多种血管内技术（“套入式”微导管技术、覆膜支架植入、凝血酶注射、球囊重塑技术、使用Onyx）联合治疗，成功治愈了假性动脉瘤，左肾动脉保持通畅，6个月随访的多层螺旋计算机断层扫描血管造影显示假性动脉瘤消失。该假性动脉瘤的大小和位置以及不同血管内治疗技术的联合应用展示了当前血管内技术的进展。不同血管内技术联合应用对于治疗复杂的医源性椎板切除术后血管损伤和肾动脉假性动脉瘤可能是一种安全可行的选择。
