Abdominal aortic injury during vertebroplasty

Area of Science:

• Interventional radiology
• Cardiovascular surgery
• Spine surgery

Background:

• Vertebroplasty is a common procedure for vertebral fractures, especially in elderly patients.
• Aortic injury is a rare but life-threatening complication of vertebroplasty.
• Limited data exists on managing iatrogenic aortic penetration during vertebroplasty.

Observation:

• An 80-year-old female experienced aortic penetration during L1 vertebroplasty.
• Arterial blood egressed from the needle, and fluoroscopy confirmed aortic injury.
• Aortic wall displacement by a hematoma was observed via contrast injection.

Findings:

• Conservative management by maintaining needle in place and controlling blood pressure was initiated.
• The patient remained hemodynamically stable, with the hematoma providing a tamponade effect.
• Post-procedure imaging confirmed no aortic leakage, and the patient recovered without complications over 2 years.

Implications:

• Conservative management can be effective for accidental aortic penetration during vertebroplasty if a tamponade effect is achieved.
• Surgical repair should be considered for circulatory collapse or suspected free wall rupture.
• This case highlights a successful conservative approach to a rare vertebroplasty complication.