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Review
. 2025 Sep 30;11(3):652-665.
doi: 10.21037/jss-25-8. Epub 2025 Jul 8.

Endovascular management of massive venous bleeding in anterior lumbar spine surgery: a narrative review

Matthew H Claydon  1   2   3 , Charlie R Faulks  1   2   3 , Gregory M Malham  1   2   4   5   6
Affiliations
Review

Endovascular management of massive venous bleeding in anterior lumbar spine surgery: a narrative review

Matthew H Claydon et al. J Spine Surg. .

Abstract

Background and objective: Anterior lumbar spine surgery provides a viable efficacious alternative to traditional posterior approaches. Vascular complications are usually managed with simple open surgical techniques. Rarely, massive venous haemorrhage transpires after a venous injury which may be life-threatening. Advanced endovascular devices and techniques provide alternatives to open surgery for the management of massive venous injury (MVI). The majority of descriptions utilise covered stents which often need to be adapted to the emergent situation and the venous anatomy. We aimed to review the venous anatomy, available endovascular devices, and describe techniques used to manage an MVI encountered during anterior lumbar spine surgery, and propose a staged, systematic approach for its endovascular management. These techniques can be used instead of, or combined with open techniques.

Methods: A review of national databases (PubMed, Ovid Medline and Google Scholar) was performed using literature from 2000 to 2024 in English. Keywords included terms "anterior" and "lumbar" and "spine" and "haemorrhage" and "venous injury" and "vascular injury" and "damage control" and "endovascular" and "venous thromboembolism". Studies that described the anatomy, incidence, endovascular surgical techniques, complications, clinical and radiological outcomes of anterior lumbar spine surgery were included.

Key content and findings: We reviewed the relevant anatomy, patient work-up, lists of useful available endovascular equipment and devices, the stages of management, specific endovascular strategies and techniques, and the post-operative management of the patient.

Conclusions: Endovascular surgery can deliver control and definitive management with lower blood loss, reduced physiological insult while preserving venous patency. It is more likely to permit the completion of the spinal procedure than open surgical repair. Expertise in endovascular techniques is mandatory for their deployment. The best outcome is only achieved with a team approach to the situation, with the recruitment of appropriately skilled personnel and equipment. Endovascular techniques should be included in contingency planning for MVI.

Keywords: Venous injury; anterior lumbar spine surgery; endovascular repair; haemorrhage; open repair.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-25-8/coif). The series “Anterior Lumbar Interbody Fusion — a definitive guide for surgeons” was commissioned by the editorial office without any funding or sponsorship. G.M.M. serves as the unpaid editorial board member of Journal of Spine Surgery. G.M.M. has disclosures of Globus Medical (consultancy), Device Technologies (travel), Life Healthcare (consultancy, travel), Australian Biotechnology (consultancy), National Surgical (travel), and SeaSpine (travel). The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Endovascular management of a massive venous injury. CFV, common femoral vein; DSA, digital subtraction angiography; ICU, intensive care unit; IJV, internal jugular vein; IV, intravenous.
Figure 2
Figure 2
Open and endovascular management of massive venous injury. CFV, common femoral vein; DSA, digital subtraction angiography; ICU, intensive care unit; IJV, internal jugular vein; IV, intravenous.
See this image and copyright information in PMC

References

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