2012, Number 4
Trauma vascular poslaminectomía lumbar. Presentación de un caso y su manejo endovascular
Rodríguez-Trejo JM, Ferrufino-Mérida AL, Blando-Ramírez S, Luna-Silva M, Pérez-Uribe R, Contreras-Lima V, Miranda-Henríquez A, Escotto-Sánchez I, Rodríguez-Ramírez N
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Language: Spanish
References: 16
Page: 144-150
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ABSTRACT
Objective: To describe a lumbar post-laminectomy vascular injury and its management by the Angiology, Vascular and Endovascular Surgery of the Centro Médico Nacional 20 de Noviembre. ISSSTE.Case report: Headquarters: hospital of the third level of attention. Female 63 years old with a positive history of smoking, 10 cigarettes/day for 10 years. Surgical history: right hemilaminectomy at L3-L4. He began his current condition 3 days after discharge by right hemilaminectomy of L3-L4 with crushing chest pain, with enlargement of right lower limb, with thrill on palpation of femoral and inguinal region dyspnea great efforts. Increasing gross hematuria. Therefore it is sent to our institution for evaluation and management. On admission, physical examination, the patient was neurologically integrated female, alert and oriented. Cylindrical neck, no carotid bruits or cervical lymphadenopathy. Thorax with rhythmic heart sounds, of appropriate intensity and frequency increased with hypoventilation in lung bases, with no alterations. Globose abdomen by adipose tissue, soft and palpable, with no evidence of peritoneal irritation, peristalsis on auscultation with this and right flank murmur that radiates to the right femoral inguinal region, with thrill on palpation. A vascular examination found the right lower limb with pulse femoral, popliteal, anterior and posterior tibial intensity three thirds and threephase linear flow Doppler. With ITB bilaterally 1.0; in left lower limb with increasing volume of 4 cm in connection with contralateral limb, with streams of pulses and the same features as the contralateral limb. Extension studies were performed: report ecocardiogram with LVEF of 59%, concentric hypertrophy, mild tricuspid regurgitation. PASP of 35 mmHg. Clinical prediction with intermediate probability of pulmonary embolism (30%). Also evident image of right iliac artery fistula into vena cava so prior surgical risk assessment Goldman II ASA II surgical procedure is performed. Left brachial access was conducted diagnostic arteriography was performed, noting the presence of pseudoaneurysm right common iliac artery of approximately 1 x 1 cm and high flow iliacocaval fistula. Underwent a second right femoral approach by dissection and femoral artery puncture arteriography performing distal and proximal covered Stent is released plus fluency 8 x 100 mm, without incident or accident. Use of contrast medium 55 cc, 100 cc bleeding. With adequate postoperative course, the patient is a graduate home two days after surgery.
Conclusions: A vascular lesion is a condition that can be catastrophic and endanger the patient’s life, so to be an index of suspicion, early diagnosis and timely treatment can reduce morbidity and mortality. Management requires a multidisciplinary and offer the possibility of endovascular surgery requires hospitals have the equipment, materials, instruments and adequate facilities and the availability of personnel trained in these techniques.
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