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Case Reports
. 2021 Feb 9:32:100401.
doi: 10.1016/j.tcr.2021.100401. eCollection 2021 Apr.

Thoracic aortic stent graft placement and simultaneous screw removal for a screw hitting the aorta

Seimei Go  1 , Shingo Mochizuki  1 , Kazunori Yamada  1 , Shinya Takahashi  2
Affiliations
Case Reports

Thoracic aortic stent graft placement and simultaneous screw removal for a screw hitting the aorta

Seimei Go et al. Trauma Case Rep. .

Erratum in

Abstract

Vascular injury caused by spinal screw displacement is a rare complication of spinal fusion surgery. Here, we report a case with no perforation of the aortic wall, which we treated by means of simultaneous thoracic endovascular aorta repair (TEVAR) and screw removal. An 82-year-old female underwent corrective spinal fixation. Postoperatively, a screw became displaced from the vertebrae and contacted the outer membrane of the descending aorta. To prevent rupture of the aorta, we performed stent graft placement from the right common femoral aorta. We left a flexion-resistant catheter in the left arm and moved the patient into an abdominal position with the left arm extended upward to enable immediate insertion of a guidewire and occlusion balloon if necessary. Then we removed the displaced screw with a drill. This safe and effective method can prevent possible aortic injuries secondary to displaced spinal screws. The key to our method is the simultaneous performance of TEVAR and screw removal, made possible through patient repositioning.

Keywords: Simultaneous operation; Spinal screw; TEVAR; Vascular injury.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
(A) Follow-up radiography showed that the upper leftmost screw was displaced from the vertebrae (arrow: displaced screw). (B) CT showed that the tip of the screw was pushing against the descending aortic wall and was probably encroaching on the outer membrane of the descending aorta (arrow: outer membrane of the descending aorta). (C) Aortography showed that the screw was pushing against the side of the aortic wall.
Fig. 2
Fig. 2
(A) Transesophageal echocardiography of the descending aorta prior to our operation. The arrows in the two panels point to the same place. Each time the aorta beat, the tip of the screw was pressing against and retreating from the arterial wall. (B) The metal rod running through the screw was drilled and broken off. With this technique, steps must be taken to mitigate the risk of vibration transmission from the drill to the screw during screw removal.
See this image and copyright information in PMC

References

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