Endovascular graft for late iatrogenic vascular complication after anterior spinal instrumentation - A case report

Study Design. Case report. Objective. To describe an endovascular treatment option for (late) vascular complications after anterior spinal instrumentation. Summary of Background Data. Severe progressive scoliosis is a well-known feature in Marfan's disease. Although overall complication rate after surgical correction of the spinal deformity is rather high, late iatrogenic complications are less frequently identified. Methods. A 40-year-old woman with Marfan's disease reported to our outpatient clinic with dyspnoe d'effort, 20 years after anterior spinal instrumentation of a thoracolumbar scoliosis. Routine screening identified a saccular aneurysm of the descending thoracic aorta. A contrast-enhanced CT scan revealed that the most proximal screw of the construct had perforated the vessel wall and caused a false aneurysm. An endovascular approach to the problem was chosen; by a transfemoral approach, an AneuRx endovascular graft was successfully implanted. Results. The patient had an uneventful postoperative course and was discharged within 5 days. At 5-year follow-up, the patient still has no clinical complaints, nor radiographic leakage nor recurrence of the false aneurysm at contrast-enhanced CT screening. Conclusion. Use of an endovascular graft is an adequate alternative for treatment of late vascular complications after anterior spinal instrumentation.