Simultaneous Endovascular Repair of a Thoracic Aortic Injury during Posterior Pedicle Screw Removal: A Case Report.

Posterior spinal stabilization is a technically demanding procedure which is increasing in popularity. Since this increase in popularity, complications, including screws misplacement, are being highlighted. Accuracy rates are higher when imaging modalities are used intraoperatively. Vascular injuries following posterior spinal stabilization are rare and are usually discovered late on subsequent imaging. Immediate perioperative compromise is rare, but nonetheless, resultant vascular injuries can be life threatening. A 72-year-old woman had a posterior spinal stabilization for severe pain caused by discitis. Routine computed tomography scan, 2 weeks postoperatively, detected an incidental thoracic aortic injury due to a misplaced pedicle screw. Given the rarity of this complication, there is no guideline for the management of resultant aortic injuries. Options described in the literature include thoracotomy with open vascular repair and newer endovascular techniques. We describe a novel method of simultaneous endovascular repair of a thoracic aortic injury during posterior pedicle screw removal with the patient in the right decubitus position. Surgeons operating near high-risk vascular structures should use intraoperative imaging modalities to guide screw placement and reduce subsequent complication rates. During endovascular repair of resultant aortic injuries, several factors must be considered. In particular, the challenge of turning a patient with open groin access and an endovascular stent in place. This must be carried out with extreme care to avoid the following risks: loss of access, damage to the access vessels and bleeding, displacement of the stent or deployment wires, and loss of the sterile field.