Book review

https://doi.org/10.20471/acc.2024.63.02.20

Combined endovascular repair of aorta and removal of penetrating pedicle screw after posterior instrumentation: a case report and literature review

Dean Girotto ; Department of Neurosurgery, Rijeka University Hospital Center, Rijeka, Croatia
Josip Burić ; Department of Neurosurgery, Rijeka University Hospital Center, Rijeka, Croatia
Hrvoje Šimić ; Department of Neurosurgery, Rijeka University Hospital Center, Rijeka, Croatia
Vjekoslav Tomulić ; Department of Cardiovascular Diseases, Rijeka University Hospital Center, Rijeka, Croatia
Tomislav Jakljević ; Department of Cardiovascular Diseases, Rijeka University Hospital Center, Rijeka, Croatia
Zvonimir Kvas ; Department of Neurosurgery, Rijeka University Hospital Center, Rijeka, Croatia *

* Corresponding author.

Abstract

Stabilization of spine using transpedicular screws is the most commonly used
instrumentation technique among spinal surgeons. The ‘free hand’ technique is considered relatively
safe and can be performed under x-ray control. Vascular injuries with misplaced screws are rare but
potentially fatal complications. Injury of thoracoabdominal aorta by malpositioned screw demands
a multidisciplinary approach. Injury of vessel wall might demand screw removal and vessel wall
repair. Here we present a case of 72-year-old female patient who underwent long segment fixation of
thoracolumbar spine. During follow up, computed tomography (CT) scan and afterwards aortography
showed a lesion of the posterior aortic wall by malpositioned screw without signs of bleeding. After
meticulous preparation, combined endovascular repair with stent-graft and removal of the penetrating
screw were performed. Endovascular treatment was performed simultaneously with screw removal.
During screw removal, the patient was in lateral decubital position. The patient was discharged on
postoperative day 8. Follow up CT aortography 6 months later showed no leak or other changes in
the aorta. We found combined endovascular vessel repair with simultaneous screw removal safe and
sufficient for this kind of aortic injury. Although lateral decubital position bears limitations, it gives
enough space for the operator. Performing intraoperative aortography provides good insight into stent
position and possible bleeding after screw removal.

Keywords

Pedicle screw; Endovascular repair; Aortic injury

Hrčak ID:

328164

URI

https://hrcak.srce.hr/328164

Publication date:

31.10.2025.

Article data in other languages: croatian

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