ArticleCureus2024
Unstable Spinal Fracture With Arteria Lusoria: Management to Mitigate Aortic Risks.
Article in Cureus, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Aortic injuries associated with unstable spinal fractures are a rare but serious condition, with high mortality. Rapid and multidisciplinary management is crucial to prevent fatal complications. We report the case of a female patient who, following a road traffic accident, presented with a displaced fracture of the fourth dorsal vertebrae (D4), with a detached anterior fragment adjacent to the posterior aspect of the aortic arch and the origin of the arteria lusoria. The multidisciplinary discussion concluded that surgery without an aortic prosthesis is associated with a major hemorrhagic risk due to aortic injury during spinal fixation manipulations, and surgery with a prosthesis is associated with immediate risks of ischemic cerebrovascular accident, gas embolism, and upper limb ischemia. We opted to prepare the patient for spinal stabilization surgery after placing the aortic prosthesis type: Zenith Alpha ZTA-PT-30-26-108 thoracic prosthesis (Cook Medical, Bloomington, Indiana, US). Our team's therapeutic approach is being discussed given the rarity of cases in the literature and the patient's anatomical characteristics. Surgical management in these situations must repair the unstable fracture while avoiding the aggravation of an existing or potential aortic injury. The aortic lesion can be treated first, before spinal fixation, either with open surgery, which carries a high risk of severe complications, or thoracic endovascular repair (TEVAR), which allows the prevention of the potential aortic injury or repair of the existing aortic injury while minimizing the side effects of open surgery. However, endovascular surgery may have limitations due to individual vascular anatomy, as in our patient's case, which can prevent optimal endograft positioning and lead to risks such as endoleak, ischemia, infection, or thrombosis, necessitating periodic radiological follow-up. Endovascular repair is a new paradigm that has improved clinical outcomes for these patients by securing the vascular injury first before spinal surgery. Teamwork and multidisciplinary discussion ensure optimal safety, minimizing the side effects of these lesions, which can be fatal at any time during management.
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