Bilateral occlusion of common iliac artery following anterior retroperitoneal approach for lumbar fracture instrumentation

Korovessis, Panagiotis; Koureas, Georgios; Zacharatos, Spyridon
June 2003
European Journal of Orthopaedic Surgery & Traumatology;Jun2003, Vol. 13 Issue 2, p111
Academic Journal
There are only four reports on unilateral occlusion of the common iliac artery following ipsilateral anterior retroperitoneal approach to the lumbar spine. To the authors' knowledge, there are no previous reports on delayed bilateral iliac artery occlusion following retroperitoneal approach. We report on a rare case of a 37-year-old paraplegic man who sought this department with bilateral iliac artery occlusion and simultaneous unilateral thromboembolism to the left popliteal artery. The problem occurred following retroperitoneal approach for instrumentation of an L2 fracture performed 2 years ago. The left leg was amputated above the knee because of gangrene, while a left-sided abdominal-to-femoral artery bypass was performed to salvage the right leg. Six months later, the right leg was amputated below the knee because the patient was admitted again with gangrene of his right foot. Following that, the loosened anterior hardware was removed via a right retroperitoneal approach. Revision surgery revealed an apposition of the common iliac vessels from the loosened hardware, while the vertebral bodies at the affected area were severely osteoporotic. Spine surgeons should be aware for the appearance of this disastrous complication following anterior retroperitoneal surgery in patients with loss of sensation in the lower extremities who do not present subjective symptoms of ischemia. The presence of hardware loosening and migration, loss of correction and pseudarthrosis are the warning signs for diagnosis of such a complication.


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