Hypoplastic inferior vena cava as a substantial risk in the lateral transpsoas approach
Introduction: Risks associated with the lateral approach for lumbar interbody fusion have been well-characterized. While much attention has been devoted to the identification and the avoidance of the lumbar plexus, there remains a significant risk to the anterior vascular and visceral structures, es...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | Annals of Vascular Surgery - Brief Reports and Innovations |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772687823000387 |
| _version_ | 1797788309458518016 |
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| author | Mueez Rehman Jeff A. Lehmen John G. Adams, Jr. |
| author_facet | Mueez Rehman Jeff A. Lehmen John G. Adams, Jr. |
| author_sort | Mueez Rehman |
| collection | DOAJ |
| description | Introduction: Risks associated with the lateral approach for lumbar interbody fusion have been well-characterized. While much attention has been devoted to the identification and the avoidance of the lumbar plexus, there remains a significant risk to the anterior vascular and visceral structures, especially when patients present with aberrant anatomical features. Methods: Retrospective chart review was performed to describe a case report of the preoperative presentation of a patient with aberrant vascular anatomy. Findings: The patient is a 48-year-old female who presented with multi-level lumbar disc degeneration with a large right para-central disc protrusion. She was considered for lateral lumber interbody fusion. During routine preoperative axial magnetic resonance imaging (MRI) review, she was noted to have large, bilateral sub-psoas vessels. A hypoplastic inferior vena cava was identified which gave rise to large, ascending lumbar veins originating from the iliac veins—one each on the lateral aspect of the mid-lateral vertebral body through the lumbar to thoracic spine. A lateral transpsoas approach at this level was felt to be associated with increased risk for a vascular injury, and a one-level TLIF at L3-L4 was performed without complication. Conclusion: This rare case highlights a vascular anomaly and illustrates the need for a preoperative axial MRI evaluation of all cases to be performed in a transpsoas manner to identify soft tissue structures which may challenge the surgical approach. |
| first_indexed | 2024-03-13T01:34:44Z |
| format | Article |
| id | doaj.art-41cb21facf3e496289b82b7efb57db8c |
| institution | Directory Open Access Journal |
| issn | 2772-6878 |
| language | English |
| last_indexed | 2024-03-13T01:34:44Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Vascular Surgery - Brief Reports and Innovations |
| spelling | doaj.art-41cb21facf3e496289b82b7efb57db8c2023-07-04T05:12:10ZengElsevierAnnals of Vascular Surgery - Brief Reports and Innovations2772-68782023-06-0132100196Hypoplastic inferior vena cava as a substantial risk in the lateral transpsoas approachMueez Rehman0Jeff A. Lehmen1John G. Adams, Jr.2University of New Mexico, School of Medicine, Albuquerque, NM, United States; Corresponding author at: University of New Mexico School of Medicine, MSC08 4720 1 UNM, Albuquerque, NM 87131-0001, United States.SSM Health Spine Surgery Center, Jefferson City, MO, United StatesSSM Health Spine Surgery Center, Jefferson City, MO, United States; Columbia Surgical Associates, Columbia, MO, United StatesIntroduction: Risks associated with the lateral approach for lumbar interbody fusion have been well-characterized. While much attention has been devoted to the identification and the avoidance of the lumbar plexus, there remains a significant risk to the anterior vascular and visceral structures, especially when patients present with aberrant anatomical features. Methods: Retrospective chart review was performed to describe a case report of the preoperative presentation of a patient with aberrant vascular anatomy. Findings: The patient is a 48-year-old female who presented with multi-level lumbar disc degeneration with a large right para-central disc protrusion. She was considered for lateral lumber interbody fusion. During routine preoperative axial magnetic resonance imaging (MRI) review, she was noted to have large, bilateral sub-psoas vessels. A hypoplastic inferior vena cava was identified which gave rise to large, ascending lumbar veins originating from the iliac veins—one each on the lateral aspect of the mid-lateral vertebral body through the lumbar to thoracic spine. A lateral transpsoas approach at this level was felt to be associated with increased risk for a vascular injury, and a one-level TLIF at L3-L4 was performed without complication. Conclusion: This rare case highlights a vascular anomaly and illustrates the need for a preoperative axial MRI evaluation of all cases to be performed in a transpsoas manner to identify soft tissue structures which may challenge the surgical approach.http://www.sciencedirect.com/science/article/pii/S2772687823000387XLIFVascularComplicationIVCAnomalyAnatomy |
| spellingShingle | Mueez Rehman Jeff A. Lehmen John G. Adams, Jr. Hypoplastic inferior vena cava as a substantial risk in the lateral transpsoas approach Annals of Vascular Surgery - Brief Reports and Innovations XLIF Vascular Complication IVC Anomaly Anatomy |
| title | Hypoplastic inferior vena cava as a substantial risk in the lateral transpsoas approach |
| title_full | Hypoplastic inferior vena cava as a substantial risk in the lateral transpsoas approach |
| title_fullStr | Hypoplastic inferior vena cava as a substantial risk in the lateral transpsoas approach |
| title_full_unstemmed | Hypoplastic inferior vena cava as a substantial risk in the lateral transpsoas approach |
| title_short | Hypoplastic inferior vena cava as a substantial risk in the lateral transpsoas approach |
| title_sort | hypoplastic inferior vena cava as a substantial risk in the lateral transpsoas approach |
| topic | XLIF Vascular Complication IVC Anomaly Anatomy |
| url | http://www.sciencedirect.com/science/article/pii/S2772687823000387 |
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