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Updated: Jul 12, 2026
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
[Hemorrhagic shock caused by iatrogenic aorto-cava injury. Case report]
Valerio Gentile1, Barbara Musco, Claudio Della Giovampaola
1Azienda Ospedaliera Universitaria Pisana, U.O. Chirurgia Generale e d'Urgenza, Dipartimento di Chirurgia, Universittà di Pisa. docgentile@fastwebnet.it
Insights
Vascular injuries during lumbar disc surgery are severe but treatable. This case highlights successful management of aorto-iliac and inferior vena cava laceration with damage control and endovascular repair, ensuring patient survival.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Trauma Management
Background:
- Vascular injuries during lumbar disc surgery are rare but life-threatening, occurring in 1-5 per 10,000 operations.
- These complications carry high morbidity and mortality rates.
Observation:
- A case of aorto-iliac and inferior vena cava (ICY) laceration occurred during lumbar disc hernia repair in a 34-year-old female.
- The patient developed sudden hypovolemic shock and retroperitoneal bleeding post-procedure.
- A pseudoaneurysm was detected post-initial repair and treated with endovascular stenting.
Findings:
- Immediate damage control, direct suture repair of vascular lacerations, and abdominal packing were performed.
- Successful endovascular stenting resolved the pseudoaneurysm.
- The patient recovered uneventfully and was discharged 11 days post-discectomy, with no significant sequels at 2-year follow-up.
Implications:
- Prompt recognition and multidisciplinary management are critical for survival in vascular injuries during spinal surgery.
- Endovascular techniques offer a viable treatment option for post-operative vascular complications.
- The presence of an "intrahospital" trauma team is vital for managing such severe intraoperative events.
Introduction:
Vascular injuries during lumbar disc surgery vary between 1 and 5 per 10,000 disc operations and usually represent life-threatening events.
Material And Methods:
The authors present a case of aorto-iliac and ICY laceration during lumbar disc hernia repair, successfully treated with immediate damage control and direct suture, followed by endovascular procedure.
Case Report:
A 34-year-old lady was operated on for a symptomatic disc herniation at L4-L5. Shortly after this procedure, an ipovolemic shock (IV degree) suddenly occurred with an evident abdominal distension. An emergent laparotomy in the same neurosurgery OR was then performed and revealed an active haemorrhage arising fJom an expansive retroperitoneal bleeding at the level of aorto-iliac bifurcation. After a proximal and distal damage control (manual compression plus aortic clamping) aortic and caval lacerations were repaired. An abdominal packing completed the procedure, due to the concomitant coagulopathy applied. At the second surgical look, carried out 24 hours after the first procedure, no active bleeding or vascular impairment were detected but an intraoperative US examination revealed a 3.5 cm wide right iliac pseudoaneurism confirmed by angioCT scan. This pseudoaneurism was later successfully treated with a double endovascular stenting. Postoperative outcome was uneventful and the patient was then discharged 11 days after the discectomy. Follow up study at 2 years did not demonstrate significant sequels.
Conclusion:
Although rare, vascular injuries during lumbar disc hernia surgery, are extremely severe complications, leading to high morbidity and mortality rates. In case of massive bleeding the presence of an "intrahospital" trauma team is a crucial factor for life-saving.
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