Endovascular management of massive venous bleeding in anterior lumbar spine surgery: a narrative review.

BACKGROUND AND OBJECTIVE

Anterior lumbar spine surgery provides a viable efficacious alternative to traditional posterior approaches. Vascular complications are usually managed with simple open surgical techniques. Rarely, massive venous haemorrhage transpires after a venous injury which may be life-threatening. Advanced endovascular devices and techniques provide alternatives to open surgery for the management of massive venous injury (MVI). The majority of descriptions utilise covered stents which often need to be adapted to the emergent situation and the venous anatomy. We aimed to review the venous anatomy, available endovascular devices, and describe techniques used to manage an MVI encountered during anterior lumbar spine surgery, and propose a staged, systematic approach for its endovascular management. These techniques can be used instead of, or combined with open techniques.

METHODS

A review of national databases (PubMed, Ovid Medline and Google Scholar) was performed using literature from 2000 to 2024 in English. Keywords included terms "anterior" and "lumbar" and "spine" and "haemorrhage" and "venous injury" and "vascular injury" and "damage control" and "endovascular" and "venous thromboembolism". Studies that described the anatomy, incidence, endovascular surgical techniques, complications, clinical and radiological outcomes of anterior lumbar spine surgery were included.

KEY CONTENT AND FINDINGS

We reviewed the relevant anatomy, patient work-up, lists of useful available endovascular equipment and devices, the stages of management, specific endovascular strategies and techniques, and the post-operative management of the patient.

CONCLUSIONS

Endovascular surgery can deliver control and definitive management with lower blood loss, reduced physiological insult while preserving venous patency. It is more likely to permit the completion of the spinal procedure than open surgical repair. Expertise in endovascular techniques is mandatory for their deployment. The best outcome is only achieved with a team approach to the situation, with the recruitment of appropriately skilled personnel and equipment. Endovascular techniques should be included in contingency planning for MVI.