Orthopedic Department, IULS (Institut Universitaire Locomoteur & du sport), University Hospital of Nice, Nice, France.
Université Côte d'Azur, CHU, Inserm, C3M, Nice, France; Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, Antibes, France.
Ann Vasc Surg. 2021 Jul;74:475-488. doi: 10.1016/j.avsg.2021.01.077. Epub 2021 Feb 4.
Anterior retroperitoneal spine exposure has become increasingly performed for the surgical treatment of various spinal disorders. Despite its advantages, the procedure is not riskless and can expose to potentially life-threatening vascular lesions. The aim of this review is to report the vascular lesions that can happen during anterior lumbar spinal surgery using mini-open retroperitoneal approach and to describe their management.
A systematic literature search was performed according to PRISMA to identify studies published in English between January 1980 and December 2019 reporting vascular complications during anterior lumbar spinal surgery with mini-open retroperitoneal approach. Three authors independently conducted the literature search on PubMed/Medline database using a combination of the following terms: "spinal surgery", "anterior lumbar surgery (ALS)", "anterior lumbar interbody fusion (ALIF)", "lumbar total disc replacement", "artificial disc replacement", "vascular complications", "vascular injuries". Vascular complications were defined as any peri-operative or post-operative lesions related to an arterial or venous vessel. The management of the vascular injury was extracted.
Fifteen studies fulfilled the inclusion criteria. Venous injuries were observed in 13 studies. Lacerations and deep venous thrombosis ranged from 0.8% to 4.3% of cases. Arterial lesions were observed in 4 studies and ranged from 0.4% to 4.3% of cases. It included arterial thrombosis, lacerations or vasospasms. The estimated blood loss was reported in 10 studies and ranged from 50 mL up to 3000 mL. Vascular complications were identified as a cause of abortion of the procedure in 2 studies, representing respectively 0.3% of patients who underwent ALS and 0.5% of patients who underwent ALIF.
Imaging pre-operative planning is of utmost importance to evaluate risk factors and the presence of anatomic variations in order to prevent and limit vascular complications. Cautions should be taken during the intervention when manipulating major vessels and routine monitoring of the limb oxygen saturation should be systematically performed for an early detection of arterial thrombosis. The training of the surgeon access remains a key-point to prevent and manage vascular complications during anterior lumbar spinal surgery with mini-open retroperitoneal.
前腹膜后脊柱显露术已广泛应用于各种脊柱疾病的外科治疗。尽管有其优点，但该手术并非没有风险，可能会导致潜在的危及生命的血管损伤。本综述旨在报告使用微创经腹膜后入路行前路腰椎脊柱手术时可能发生的血管病变，并描述其处理方法。
根据 PRISMA 进行系统文献检索，以确定 1980 年 1 月至 2019 年 12 月期间以英文发表的报告微创经腹膜后前路腰椎脊柱手术血管并发症的研究。三位作者独立使用以下术语的组合在 PubMed/Medline 数据库上进行文献检索：“脊柱手术”、“前路腰椎手术（ALS）”、“前路腰椎椎间融合术（ALIF）”、“腰椎全椎间盘置换术”、“人工椎间盘置换术”、“血管并发症”、“血管损伤”。血管并发症定义为与动脉或静脉相关的任何围手术期或术后损伤。提取了血管损伤的处理方法。
符合纳入标准的研究有 15 项。13 项研究观察到静脉损伤。切开伤和深静脉血栓形成的发生率为 0.8%至 4.3%。4 项研究观察到动脉损伤，发生率为 0.4%至 4.3%。其中包括动脉血栓形成、切开伤或血管痉挛。有 10 项研究报告了估计失血量，范围从 50 毫升到 3000 毫升。2 项研究将血管并发症确定为手术中止的原因，分别占接受 ALS 和接受 ALIF 的患者的 0.3%和 0.5%。
术前影像学规划非常重要，可评估风险因素和解剖变异的存在，以预防和限制血管并发症。在操作大血管时应谨慎，并应系统地监测肢体氧饱和度，以便早期发现动脉血栓形成。微创经腹膜后前路腰椎脊柱手术中，外科医生的培训仍然是预防和处理血管并发症的关键。
