Renal artery injury during lateral transpsoas interbody fusion: case report

Lateral interbody fusion (LIF) via the retroperitoneal transpsoas approach is an increasingly popular, minimally invasive technique for interbody fusion in the thoracolumbar spine that avoids many of the complications of traditional anterior and transforaminal approaches. Renal vascular injury has been cited as a potential risk in LIF, but little has been documented in the literature regarding the etiology of this injury. The authors discuss a case of an intraoperative complication of renal artery injury during LIF. A 42-year-old woman underwent staged T12–L5 LIF in the left lateral decubitus position, and L5–S1 anterior lumbar interbody fusion, followed 3 days later by T12–S1 posterior instrumentation for idiopathic scoliosis with radiculopathy refractory to conservative management. After placement of the T12–L1 cage, the retractor was released and significant bleeding was encountered during its removal. Immediate consultation with the vascular team was obtained, and hemostasis was achieved with vascular clips. The patient was stabilized, and the remainder of the procedure was performed without complication. On postoperative CT imaging, the patient was found to have a supernumerary left renal artery with complete occlusion of the superior left renal artery, causing infarction of approximately 75% of the kidney. There was no increase in creatinine level immediately postoperatively or at the 3-month follow-up. Renal visceral and vascular injuries are known risks with LIF, with potentially devastating consequences. The retroperitoneal transpsoas approach for LIF in the superior lumbar spine requires a thorough knowledge of renal visceral and vascular anatomy. Supernumerary renal arteries occur in 25%–40% of the population and occur most frequently on the left and superior to the usual renal artery trunk. These arteries can vary in number, position, and course from the aorta and position relative to the usual renal artery trunk. Understanding of renal anatomy and the potential variability of the renal vasculature is essential to prevent iatrogenic injury.

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Stereotactic navigation for the prepsoas oblique lateral lumbar interbody fusion: technical note and case series

Neurosurgical FOCUS ◽

10.3171/2017.5.focus17168 ◽

2017 ◽

Vol 43 (2) ◽

pp. E14 ◽

Cited By ~ 16

Author(s):

Anthony M. DiGiorgio ◽

Caleb S. Edwards ◽

Michael S. Virk ◽

Praveen V. Mummaneni ◽

Dean Chou

Keyword(s):

Interbody Fusion ◽

Case Series ◽

Psoas Muscle ◽

Technical Note ◽

Invasive Technique ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Transpsoas Approach ◽

Technical Report ◽

Stereotactic Navigation

The prepsoas retroperitoneal approach is a minimally invasive technique used for anterior lumbar interbody fusion. The approach may have a more favorable risk profile than the transpsoas approach, decreasing the risks that come with dissecting through the psoas muscle. However, the oblique angle of the spine in the prepsoas approach can be disorienting and challenging. This technical report provides an overview of the use of navigation in prepsoas oblique lateral lumbar interbody fusion in a series of 49 patients.

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Iatrogenic Renal Artery Injury Necessitating Nephrectomy Following Lumbar Interbody Fusion for Tubercular Spondylodiscitis

Indian Journal of Orthopaedics ◽

10.1007/s43465-021-00414-5 ◽

2021 ◽

Author(s):

Gurpremjit Singh ◽

Pankaj Kandwal ◽

Vikas Kumar Panwar ◽

Sunil Kumar ◽

Ankur Mittal ◽

...

Keyword(s):

Renal Artery ◽

Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Artery Injury

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A Unique Case of Incomplete Bifid Ureter and Associated Arterial Variations

Case Reports in Urology ◽

10.1155/2021/6655813 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Shivika Ahuja ◽

Hannah Sullivan ◽

Mark Noller ◽

Yun Tan ◽

Daniel Daly

Keyword(s):

Renal Artery ◽

Imaging Techniques ◽

Left Kidney ◽

Anatomical Variations ◽

Left Renal Artery ◽

Renal Vasculature ◽

Duplex Kidney ◽

Ovarian Artery ◽

Psoas Major Muscle ◽

Bifid Ureter

Introduction. Urogenital and vascular anomalies, including a left duplex kidney and a left aberrant renal artery that gave rise to the left ovarian artery, were observed in a 77-year-old female cadaver during a routine dissection. Description. A left aberrant renal artery, which gave rise to the left ovarian artery, was observed originating from the aorta 4 cm below the left renal artery. Two independent contributions to a bifid ureter were found originating from the hilum of the left kidney. These two contributions descended 12.4 cm and 10.6 cm, respectively, posterior to the left aberrant renal artery and lateral to the left ovarian artery before uniting anterior to the psoas major muscle to descend 12.7 cm to the bladder. Significance. While the duplex kidney is a relatively common congenital anomaly that can be asymptomatic, it can also potentially be associated with compression of renal vasculature or the ureter. Ureteral compression can then result in several pathologies including reflux, urinary tract infection (UTI), ureteropelvic junction obstruction, or hydronephrosis. Compression of renal and ovarian vasculature can result in altered blood flow to the kidney and ovary, potentially causing fibrosis, atrophy, or organ failure. Current imaging techniques alone are insufficient for correct diagnostics of such complications, and they must be supplemented with a thorough understanding of the respective anatomical variations.

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Role of CT Angiography in Diagnosis of Reno-Vascular Abnormalities

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2031117 ◽

2021 ◽

pp. 155-161

Author(s):

Diaa Mustafa Ismail Marei ◽

Rasha Mahmoud Dawoud ◽

Ghada Mahmoud Al Ghazaly ◽

Abdelmonem Nooman Darwesh

Keyword(s):

Renal Artery ◽

Ct Angiography ◽

Artery Aneurysm ◽

Invasive Technique ◽

Outpatient Basis ◽

Renal Vasculature ◽

Vascular Abnormalities ◽

Post Procedure ◽

Imaging Department

Background: Reno-vascular disease is a complex disorder, the most common cause of which is RAS. Multi detector computed tomography angiography (MDCTA) plays an important role in assessment of the renal vasculature. Despite conventional angiography is still considered the gold standard in reno-vascular imaging, MDCTA is increasingly used as it is less invasive, easily applicable and available. Aim of the Study: In our study we aimed to assess the role of CT Angiography in diagnosis of renal vasculature abnormalities. Patients and Methods: This prospective study was carried out at The Radio-diagnosis and Medical Imaging Department in our institute, conducted on 40 Patients who are clinically suspected to have reno-vascular abnormalities in the period from September 2018 to February 2021. Their ages ranged from 33 to 56 years old. Results: Based on CTA findings, out of 40 patients, 6 (15%) patients were confirmed to have accessory renal arteries, 6 (15%) patients had renal artery aneurysm, 6 (15%) patients had nutcracker syndrome, 6 (15%) patients had dual venous drainage of both kidneys, two of them showed retro-aortic left renal vein &10 (25%) patients were confirmed to have renal artery stenosis. Conclusion: CT Angiography with multiplanar reconstruction and three-dimensional display is valuable in studying patients with reno-vascular lesions involving the proximal renal vessels. MDCT angiography is advantageous being a non-invasive technique that can be done on outpatient basis without pre or post-procedure admission, no special post-procedure care and less cost.

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Clinical Evaluation of Microendoscopy-Assisted Oblique Lateral Interbody Fusion

Medicina ◽

10.3390/medicina57020135 ◽

2021 ◽

Vol 57 (2) ◽

pp. 135

Author(s):

Tomohide Segawa ◽

Hisashi Koga ◽

Masahito Oshina ◽

Katsuhiko Ishibashi ◽

Yuichi Takano ◽

...

Keyword(s):

Interbody Fusion ◽

Outcome Measure ◽

Operation Time ◽

Secondary Outcome ◽

Invasive Technique ◽

Lateral Interbody Fusion ◽

Surgical Methods ◽

Significant Difference ◽

Oblique Lateral Interbody Fusion ◽

Lateral Interbody

Background and objectives: Oblique Lateral Interbody Fusion (OLIF) is a widely performed, minimally invasive technique to achieve lumbar lateral interbody fusion. However, some complications can arise due to constraints posed by the limited surgical space and visual field. The purpose of this study was to assess the short-term postoperative clinical outcomes of microendoscopy-assisted OLIF (ME-OLIF) compared to conventional OLIF. Materials and Methods: We retrospectively investigated 75 consecutive patients who underwent OLIF or ME-OLIF. The age, sex, diagnosis, and number of fused levels were obtained from medical records. Operation time, estimated blood loss (EBL), and intraoperative complications were also collected. Operation time and EBL were only measured per level required for the lateral procedure, excluding the posterior fixation surgery. The primary outcome measure was assessed using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The secondary outcome measure was assessed using the Oswestry Disability Index (ODI) and the European Quality of Life–5 Dimensions (EQ-5D), measured preoperatively and 1-year postoperatively. Results: This case series consisted of 14 patients in the OLIF group and 61 patients in the ME-OLIF group. There was no significant difference between the two groups in terms of the mean operative time and EBL (p = 0.90 and p = 0.50, respectively). The perioperative complication rate was 21.4% in the OLIF group and 21.3% in the ME-OLIF group (p = 0.99). In both groups, the postoperative JOABPEQ, EQ-5D, and ODI scores improved significantly (p < 0.001). Conclusions: Although there was no significant difference in clinical results between the two surgical methods, the results suggest that both are safe surgical methods and that microendoscopy-assisted OLIF could serve as a potential alternative to the conventional OLIF procedure.

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Microendoscopy-assisted extraforaminal lumbar interbody fusion for treating single-level spondylodesis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02313-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Motohide Shibayama ◽

Guang Hua Li ◽

Li Guo Zhu ◽

Zenya Ito ◽

Fujio Ito

Keyword(s):

Minimally Invasive ◽

Spinal Canal ◽

Interbody Fusion ◽

Facet Joint ◽

Clinical Results ◽

Invasive Technique ◽

Clinical Effects ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Single Level

Abstract Background Lumbar interbody fusion is a standard technique for treating degenerative lumbar disorders involving instability. Due to its invasiveness, a minimally invasive technique, extraforaminal lumbar interbody fusion (ELIF), was introduced. On surgically approaching posterolaterally, the posterior muscles and spinal canal are barely invaded. Despite its theoretical advantage, ELIF is technically demanding and has not been popularised. Therefore, we developed a microendoscopy-assisted ELIF (mELIF) technique which was designed to be safe and less invasive. Here, we aimed to report on the surgical technique and clinical results. Methods Using a posterolateral approach similar to that of lateral disc herniation surgery, a tubular retractor, 16 or 18 mm in diameter, was placed at the lateral aspect of the facet joint. The facet joint was partially excised, and the disc space was cleaned. A cage and local bone graft were inserted into the disc space. All disc-related procedures were performed under microendoscopy. The spinal canal was not invaded. Bilateral percutaneous screw-rod constructs were inserted and fixed. Results Fifty-five patients underwent the procedure. The Oswestry Disability Index and visual analogue scale scores greatly improved. Over 90% of the patients obtained excellent or good results based on Macnab’s criteria. There were neither major adverse clinical effects nor the need for additional surgery. Conclusions mELIF is minimally invasive because the spinal canal and posterior muscles are barely invaded. It produces good clinical results with fewer complications. This technique can be applied in most single-level spondylodesis cases, including those involving L5/S1 disorders.

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Giant Aneurysm of Renal Artery: Surgical Management

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000222 ◽

2002 ◽

Vol 10 (2) ◽

pp. 176-177 ◽

Cited By ~ 5

Author(s):

Lokeswara Rao Sajja ◽

Sitaram Reddy Benjaram ◽

Sarbeswar Sahariah ◽

Vijay Kumar Devaraj

Keyword(s):

Renal Artery ◽

Surgical Management ◽

Giant Aneurysm ◽

Left Renal Artery ◽

Abdominal Ultrasonography ◽

Renal Arteriography

Giant aneurysm of the renal artery is rare even though renal artery aneurysms are diagnosed more often since the introduction of abdominal ultrasonography and selective renal arteriography. A 52-year-old man with an aneurysm of the left renal artery measuring 16 × 13 × 10 cm presented with features of an expanding aneurysm. He underwent resection of the aneurysm and a left nephrectomy.

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Origin, Traject and Distribution of Renal Arteries (Arteriae renalis) in Chinchilla lanigera

Bulletin of University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca Veterinary Medicine ◽

10.15835/buasvmcn-vm:002517 ◽

2018 ◽

Vol 75 (1) ◽

pp. 129

Author(s):

Cristian MARTONOS ◽

Cristian DEZDROBITU ◽

Florin STAN ◽

Aurel DAMIAN ◽

Alexandru GUDEA

Keyword(s):

Renal Artery ◽

Renal Arteries ◽

Left Renal Artery ◽

Lateral Part ◽

Formaldehyde Solution ◽

Anatomical Dissection ◽

The Right ◽

High Degree ◽

Aorta Abdominalis ◽

Degree Of Similarity

For the present study a number of 5 female chinchilla carcasses were used. The animals were slaughtered for commercial purpuses (fur). The anatomical dissection started with the identification of the aorta (Aorta abdominalis). The next step was the intra-arterial injection of a colouring substance. The carcasses was fixed in the formaldehyde solution and subsequently the renal arteries were dissected. The first renal artery was the right renal artery (Arteria renalis dextra) and, at 0,5 cm caudally, the left renal artery (Arteria renalis sinister) arose . The origin of those arteries were disposed on the lateral part of the abdominal aorta.The origin, traject and distribution of renal arteries on the studied species have a high degree of similarity with the literature dates described for leporids.

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