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首页> 外文期刊>Annals of vascular surgery >Simultaneous Endovascular Repair of a Thoracic Aortic Injury during Posterior Pedicle Screw Removal: A Case Report
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Simultaneous Endovascular Repair of a Thoracic Aortic Injury during Posterior Pedicle Screw Removal: A Case Report

机译：后椎弓根螺钉螺杆螺栓术后同时腹血管修复胸膜损伤：案例报告

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摘要

Posterior spinal stabilization is a technically demanding procedure which is increasing in popularity. Since this increase in popularity, complications, including screws misplacement, are being highlighted. Accuracy rates are higher when imaging modalities are used intraoperatively. Vascular injuries following posterior spinal stabilization are rare and are usually discovered late on subsequent imaging. Immediate perioperative compromise is rare, but nonetheless, resultant vascular injuries can be life threatening. A 72-year-old woman had a posterior spinal stabilization for severe pain caused by discitis. Routine computed tomography scan, 2 weeks postoperatively, detected an incidental thoracic aortic injury due to a misplaced pedicle screw. Given the rarity of this complication, there is no guideline for the management of resultant aortic injuries. Options described in the literature include thoracotomy with open vascular repair and newer endovascular techniques. We describe a novel method of simultaneous endovascular repair of a thoracic aortic injury during posterior pedicle screw removal with the patient in the right decubitus position. Surgeons operating near high-risk vascular structures should use intra-operative imaging modalities to guide screw placement and reduce subsequent complication rates. During endovascular repair of resultant aortic injuries, several factors must be considered. In particular, the challenge of turning a patient with open groin access and an endovascular stent in place. This must be carried out with extreme care to avoid the following risks: loss of access, damage to the access vessels and bleeding, displacement of the stent or deployment wires, and loss of the sterile field.
机译：后脊柱稳定是一种技术上要求越来越受欢迎的程序。由于这种普及的增加，并发症，包括螺钉错位，正在突出显示。当术中使用成像模式时，精度率较高。后脊柱稳定后的血管损伤是罕见的，通常在随后的成像后被发现。即时围手术期妥协是罕见的，但仍然可以造成血管损伤的血管损伤。一个72岁的女性对椎间盘炎引起的严重疼痛有后脊柱稳定。术语术后2周的常规计算断层扫描扫描，检测到由于错位椎弓根螺钉而偶然的胸腔主动脉损伤。鉴于这种并发症的稀有性，没有导致主动脉损伤的管理指导。文献中描述的选项包括开放的血管修复和更新的血管内技术的胸廓切开术。我们描述了一种新的椎间囊主动脉损伤同时腹血管修复的方法，在右侧褥疮患者与患者移除椎弓根螺钉。在高风险血管结构附近操作的外科医生应使用术中的术中的成像模态来引导螺钉放置并降低随后的并发症率。在所得主动脉造成的血管内修复过程中，必须考虑几个因素。特别是，用开放的腹股沟接入和血管内支架转动患者的挑战。这必须以极度注意地进行，以避免以下风险：丧失访问，接入容器损坏，损坏，支架或部署线的排量，以及无菌磁场的损失。

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