Department of Orthopedics, Hualien Tzu Chi Hospital, Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan.
Sports Medical Center, Hualien Tzu Chi Hospital, Hualien 970, Taiwan.
Medicina (Kaunas). 2022 Jul 13;58(7):927. doi: 10.3390/medicina58070927.
An 80-year-old man was admitted with an L5 compression fracture, L4/5 spondylolisthesis, and L5 radiculopathy and underwent a TLIF procedure. Refractory hypotension occurred, though it indicated a possible great vessel injury with vasopressor and fluid infusion. Emergent intraoperative angiography was performed, which showed extravasation at the right common iliac artery. Resuscitative endovascular balloon occlusion of the aorta followed by right common iliac artery stenting was successfully performed to arrest the bleeding. The iatrogenic right common iliac artery laceration was complicated with abdomen compartment syndrome and acute kidney injury. The patient received supportive care, including continuous venovenous hemofiltration (CVVH) for a week, after which the patient's condition improved. The patient did not have any residual complications at the one-month follow-up. Great vessel injury during the TLIF procedure is rare but fatal. Refractory hypotension is indicative of a great vessel injury. Endovascular intervention is a fast and promising method to diagnose and treat arterial injury.
一位 80 岁男性因 L5 压缩性骨折、L4/5 脊椎滑脱和 L5 神经根病变入院，并接受了 TLIF 手术。尽管给予了血管加压药和液体输注，但仍出现难治性低血压，提示可能存在大血管损伤。紧急进行术中血管造影检查，显示右髂总动脉外渗。随后成功实施了主动脉球囊阻断复苏术和右髂总动脉支架置入术以止血。医源性右侧髂总动脉裂伤合并腹腔间隔室综合征和急性肾损伤。患者接受了支持性治疗，包括持续静脉-静脉血液滤过（CVVH）一周，此后患者情况改善。在一个月的随访时，患者没有任何残留并发症。TLIF 手术过程中大血管损伤罕见但致命。难治性低血压提示大血管损伤。血管内介入是诊断和治疗动脉损伤的快速有前途的方法。
