[Percutaneous placement of covered stents for treatment of post discectomy arterial rupture]. / Rotura arterial posdiscectomía. Tratamiento mediante implante percutáneo de una endoprótesis cubierta.

INTRODUCTION: Vascular lesions produced as a consequence of surgical spinal treatment are rare, but serious. Fast diagnosis and treatment are essential in lesions that produce massive blood loss. Following the use of non covered stents in the treatment of peripheral vascular stenotic obstructive pathologies, the appearance of covered stents allowed aneurysms, pseudo aneurysms, fistulas or bleedings to be treated. Being able to graft a stent in serious patients, during diagnosis itself, with a minimum amount of aggression and local anaesthesia affords this technique huge advantages over others. CASE REPORT: In this work we report the case of an arterial rupture which came about as a complication of a discectomy. After the surgical intervention, there was an important haematocrit reduction within a short space of time. The patient s quickly becoming anaemic and the existence of a retroperitoneal mass of heterogeneous echogenicity pointed towards a postoperative haemorrhage. This was confirmed by arteriography, which revealed an important contrast extravasation. A covered stent was placed at the same time and, in the post graft follow up, it was confirmed that there was no bleeding. At 12 hours after the operation the patient was moved from the postoperative recovery unit to a hospital ward and, 5 days later, was discharged. In a check up carried out in the Neurosurgery unit 2 months after being sent home, the patient was found to be asymptomatic. CONCLUSION: The placement of covered stents is a valid therapeutic option for treating postoperative haemorrhagic lesions. It can be performed at the same time as diagnosis and does not require general anaesthesia. In the case we have described, the patient recovered quickly and ambulatory check ups showed he continued to be asymptomatic

Rotura arterial posdiscectomía. Tratamiento mediante implante percutáneo de una endoprótesis cubierta / Percutaneous placement of covered stents for treatment of post-discectomy arterial rupture

Introducción. Las lesiones vasculares como consecuencia de tratamientos quirúrgicos espinales son complicaciones raras, pero graves. La rapidez en el diagnóstico y el tratamiento son esenciales en lesiones que producen pérdidas hemáticas masivas. A la utilización de endoprótesis no cubiertas en el tratamiento de la patología estenosicoobstructiva vascular periférica, le siguió la aparición de las endoprótesis cubiertas, que abrieron la posibilidad de tratar aneurismas, pseudoaneurismas, fístulas o sangrados. El hecho de poder implantar una endoprótesis en pacientes graves, en el mismo acto diagnóstico, con una agresión mínima y con anestesia local, le confiere grandes ventajas a esta técnica. Caso clínico. En este trabajo se presenta una rotura arterial como complicación de una discectomía. Tras el acto quirúrgico, el paciente presentó una reducción importante del hematocrito, en un corto período. La anemización rápida y la existencia de una masa de ecogenicidad heterogénea retroperitoneal orientaron hacia una hemorragia posquirúrgica, que se confirmó mediante una arteriografía, que demostró un extravasado importante de contraste. Se liberó una endoprótesis cubierta en el mismo acto, y se observó, en el control postimplante, la inexistencia de sangrado. A las 12 horas posprocedimiento, el paciente se trasladó desde la Unidad de Reanimación a la planta de hospitalización y, a los cinco días se le dio el alta. En un control realizado en el Servicio de Neurocirugía, a los dos meses del alta, el paciente se encontraba asintomático. Conclusión. El implante de endoprótesis cubiertas es una opción terapéutica apropiada para el tratamiento de lesiones hemorrágicas posquirúrgicas. Puede realizarse en el mismo acto diagnóstico y no necesita anestesia general. En el caso aquí descrito, el paciente presentó una recuperación rápida y el control ambulatorio demostró que seguía asintomático (AU)

[Percutaneous treatment of peripheral vascular malformations]. / Tratamiento percutáneo de las malformaciones vasculares periféricas.

OBJECTIVE: Vascular malformations are uncommon pathologic entities in which surgery is usually not possible or is inefficient. Our experience with the percutaneous treatment of peripheral vascular malformations, by means of transarterial embolization or direct puncture is here reported. MATERIAL AND METHODS: During the 1993-1997 period a total of 35 patient, 20 females (57%) and 15 males (43%) aged 11 to 75 years, were treated at our Unit. Sixteen vascular malformations were hemodynamically active (45.7%) and 19 hemodynamically inactive (54.3%). A total of 126 embolizations (mean 3.6) were performed. Malformations were studied by means of doppler-echography, magnetic resonance, arteriography and direct puncture angiography. Considering location, size and hemodynamic characteristics a specific approach and therapy was performed in each case. In two cases (5.7%) a surgical exeresis after embolization was performed. RESULTS: A technical success, defined as the possibility of embolizing the malformation, was achieved in 100% of cases. No technical complications during the procedure occurred. The mean follow-up time was 23 months (6-69). All patients but one improved both objectively and subjectively and all but one have recovered their daily activities in the following days. The exception was one patient who developed a severe complication--cutaneous necrosis--a few days after the procedure which required repairing surgery. All patient had edema, pain and increased functional impairment after the embolization which subsided with medical treatment. CONCLUSIONS: Percutaneous embolization of vascular malformations is an effective method associated with a low complication rate. Our results are encouraging although more extensive investigation are required to draw definite conclusions.