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Tummala et al. Postoperative complications of spinal surgery

Figure 1: Enhanced computed tomography of thorax and abdomen
imaging (sagittal reformation) shows a complete thrombosis of the
distal aorta below the left renal artery, extending to the common
iliac bifurcations
studies were normal. No abnormal cardiac rhythm
including atrial fibrillation was detected in the telemetry.
Transesophageal echocardiography ruled out any left
atrial thrombus. There were no compressive lymph
nodes or any other structure compressing on the
aorta. Diagnosis of acute Leriche’s syndrome was
established which was attributed to acute vascular
injury following ALIF. The patient underwent emergent
aortoiliac endarterectomy and aorta bifemoral bypass. Figure 2: Enhanced computed tomography imaging (axial)
demonstrates an acute thrombus in the abdominal aorta causing
During the surgery, acute thrombus was found in the complete occlusion
more proximal infrarenal aorta which was retrieved
and then dacron graft was placed. His postoperative risk of intra, peri, and postoperative complications. A
[7]
[8]
period was uneventful with complete resolution systematic review conducted by Wood et al. showed
of symptoms within next 48 h. Postoperative, the that vascular injury in elective anterior lumbosacral
patient was started on antithrombotic therapy. surgery is less than 5% and complications being
The symptoms completely resolved post vascular thrombosis, pulmonary embolism, and prolonged
surgery interventions and he was followed up as hospitalization. It is shown that vascular complications
an outpatient after a week. He resumed his regular after ALIF range from 1.9% to 5.6% in the general
lifestyle without any residual symptoms. Although the population. [5,9,10] The vascular complications can
patient had risk factors for Leriche’s syndrome, the be in the form of acute thrombosis, retroperitoneal
acuity of the presentation was attributed to his recent hemorrhage, and injury to the major blood vessels.
surgical intervention where abdominal aorta was likely
traumatized. The injury to aortic endothelium resulted We highlight the rare case of acute Leriche’s syndrome
in acute thrombus formation. following ALIF surgery which was initially misdiagnosed.
Firstly, the patient’s presentation of sensory and motor
DISCUSSION impairment misled physicians to have an impression
of neuropathy. Secondly, ischemic neuropathy is rarely
Leriche’s syndrome is an occlusive disease of the caused by Leriche’s syndrome. [11,12] Another reason
aorta which is characterized by a triad of symptoms for misdiagnosis is his recent spinal surgery. Though
like erectile dysfunction, claudication of thighs and legs the patient was at risk for thrombus formation due to
and diminished or absent femoral pulse. [6] risk factors and atherosclerosis, the interesting part
was the acute presentation of symptoms. There was
There are many causes of acute Leriche’s syndrome a case study in 2003 which reported 8 cases arterial
like surgical manipulation, trauma, thromboembolic complication following ALIF in which possible risk
disease, hypercoagulability, atrial fibrillation, neoplasm, factors were analyzed. The authors encountered 6
intraplaque hemorrhage in an aneurysm. Post-surgical cases of common iliac artery occlusion and two cases of
Leriche’s syndrome is rare and needs a strong index acute vasospasm as a complication of ALIF. Another
[5]
of suspicion to diagnose. Surgical treatment of adult article in 2010 documented the incidence of vascular
lumbar spinal disorders is associated with substantial complications during ALIF in 212 consecutive patients,
Vessel Plus ¦ Volume 1 ¦ September 26, 2017 157