Aortoiliac vascular injuries after misplacement of fixation screws

Abstract

Purpose: To report our experience with the diagnosis and treatment of aortoiliac vascular injuries caused by misplaced orthopedic fixation screws.

Materials: Six patients (age range, 35-60 years; mean, 52 years) were diagnosed with seven arterial injuries related to misplacement of fixation screws. The location of the injuries were thoracic aorta (n = 4) and common iliac arteries (n = 3). There was vessel wall penetration in five injuries resulting in active bleeding in two patients, contained penetrations in two patients, and vessel occlusion in one patient. One patient had associated inferior vena cava injury and pulmonary embolism. Two patients had asymptomatic impingement of the aortic wall by the screws.

Results: Vascular injuries resulted in death in one patient and limb amputation in another patient. Three patients were treated with placement of stent grafts and screw removal. Screw replacement was performed in one patient. Conservative observation was done in one patient.

Conclusions: Vascular injuries related to misplacement of fixation screws are relatively infrequent but potential life and limb-threatening complications that require early recognition with prompt repair of vascular lesions and screw reposition.