Purpose: To study the clinical and pathophysiologic characteristics and summarize the experience of treatment of abdominal vascular injury related to lumbar surgery.
Methods: We analyzed patients who suffered abdominal vascular injury during lumbar surgery in our hospital retrospectively and reviewed related literature in the PUBMED database from 2002 to 2017. Combined with the existing treatment options and outcomes, we investigated further and summarized our findings.
Results: With the data from our hospital, four cases of injuries were included, i.e., left common iliac artery and vein (CIA and CIV), left internal iliac artery, and inferior vena cava. Almost all of the patients (one exception) manifesting unstable haemodynamics were primarily treated by traditional vessel suture. After treatment, two patients died eventually, while the others recovered well at follow-up. With the reported data, 77 patients with the most frequently type of laceration (58.4%) were included. For vascular laceration, unstable haemodynamics was diagnosed in most of the patients (88.9%); CIA and CIV accounted for the all the most common patients (78.7%). Extracted from these data, traditional surgical method was selected to repair laceration prevalently (86.7%), while arteriovenous fistula and pseudoaneurysm were treated with an interventional procedure. Negative outcomes included two deaths, two suffered lower limb deep vein thrombosis, and two suffered graft infection.
Conclusions: Different treatment choices should be conducted depending on different injury characteristics and patients' condition. Moreover, early recognition and prompt treatment are critical components to successful rescue. When a vascular injury is suspected, ultrasonography and positive abdominal exploration are recommended together with unified leadership in the rescue team.
Keywords: Diagnosis and treatment process; Experience summary; Iatrogenic vascular injury; Lumbar surgery; Rescue.