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Title of Journal: Eur J Orthop Surg Traumatol

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Abbravation: European Journal of Orthopaedic Surgery & Traumatology

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Springer-Verlag

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1432-1068

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Bilateral occlusion of common iliac artery followi

Authors: Panagiotis Korovessis Georgios Koureas Spyridon Zacharatos
Publish Date: 2003/05/29
Volume: 13, Issue: 2, Pages: 111-114
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Abstract

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 37yearold 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 leftsided abdominaltofemoral 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 complicationOn ne retrouve que quatre publications docclusion unilatérale de lartère iliaque primitive après abord rétropéritonéal ipsilatéral du rachis lombaire A la connaissance des auteurs il nexiste aucune publication sur une occlusion bilatérale dans un tel abord rétropéritonéal Nous rapportons le cas dun homme âgé de 37 ans paraplégique qui séjourna dans notre service avec une occlusion bilatérale et une thrombose par embolie de lartère poplitée gauche à la suite dun abord rétropéritonéal qui avait été effectué deux ans auparavant pour stabiliser par instrumentation une fracture de L2 Le membre inférieur gauche dut être amputé au dessus du genou en raison dune gangrène et un bypass abdominofémoral gauche dut être réalisé pour sauver le membre inférieur droit Six mois plus tard on dut amputer la jambe droite sous le genou en raison dune gangrène du pied Dans les suites il fut procédé à lablation du matériel par un abord rétropéritonéal à droite Le contrôle chirurgical permit la découverte dune adhérence entre lartère iliaque primitive et le matériel dostéosynthèse qui avait migré les corps vertébraux concernés étaient fortement ostéoporotiques En conclusion les chirurgiens du rachis doivent être conscients dune telle complication catastrophique après abord rétropértionéal du rachis lombaire chez des patients ayant perdu la sensibilité aux membres inférieurs et ne se plaignant pas de ce fait de symptomes ischémiques La présence de matériel dostéosynthèse débricolé ayant migré la notion dune perte de correction et dune pseudarthrose sont les signes dalarme qui doivent faire évoquer la crainte dun tel diagnostic


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