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Development of paravertebral pseudoaneurysms following vertebral augmentation: a report of two cases

      Highlights

      • Pseudoaneurysm formation following vertebral augmentation is rare and difficult to manage due to the atypical location.
      • Embolization may be performed via direct puncture or a trans-arterial approach, as with pseudoaneurysms in other locations.
      • Appropriate management hinges on a comprehensive understanding of spinal arterial anatomy.

      Abstract

      Paravertebral pseudoaneurysms are infrequent following vertebral augmentation but can be difficult to manage due to their proximity to the arterial supply of the spinal cord. Here, we present two distinct manifestations of this complication with associated anatomy and management. In the first, a pseudoaneurysm developed following radiofrequency ablation and kyphoplasty at the L2 and L4 levels. Direct puncture embolization initially failed to close the pseudoaneurysm, but stasis was ultimately achieved via trans-arterial embolization. In the second, vertebral augmentation at the T9 and T11-L3 levels was complicated by formation of a pseudoaneurysm fed by a segmental artery and a long paravertebral anastomotic vein. Due to the patient's poor medical status, intervention was not performed. Understanding vertebral arterial anatomy is crucial for preventing and treating vascular injury in vertebral augmentation.

      Keywords

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      References

        • Tomasian A.
        • Jennings J.W.
        Percutaneous interventional techniques for treatment of spinal metastases.
        Semin intervent Radiol. 2020; 37: 192-198
        • Madassery S.
        Vertebral compression fractures: evaluation and management.
        Semin intervent Radiol. 2020; 37: 214-219
        • Barragán-Campos H.M.
        • et al.
        Percutaneous vertebroplasty for spinal metastases: complications.
        Radiology. 2006; 238: 354-362
        • Laredo J.D.
        • Hamze B.
        Complications of percutaneous vertebroplasty and their prevention.
        Skeletal Radiol. 2004; 33: 493-505
        • Yevich S.
        • Tselikas L.
        • Gravel G.
        • de Baère T.
        • Deschamps F.
        Percutaneous cement injection for the palliative treatment of osseous metastases: a technical review.
        SeminIntervRadiol. 2018; 35: 268-280
        • Biafora S.J.
        • Mardjetko S.M.
        • Butler J.P.
        • McCarthy P.L.
        • Gleason T.F.
        Arterial injury following percutaneous vertebral augmentation: a case report.
        Spine. 2006; 31: E84
      1. . D. H. Heo Y. J. Cho Segmental Artery Injury Following Percutaneous Vertebroplasty Using Extrapedicular Approach. Journal of Korean Neurosurgical Society 49, 131–133.

        • Puri A.S.
        • et al.
        Lumbar artery pseudoaneurysm after percutaneous vertebroplasty: a unique vascular complication: report of 2 cases.
        J Neurosurg Spine. 2011; 14: 296-299
        • Giordano A.
        • et al.
        Interventional radiology management of a ruptured lumbar artery pseudoaneurysm after cryoablation and vertebroplasty of a lumbar metastasis.
        Cardiovasc Intervent Radiol. 2016; 40: 776-779
        • Dausse F.
        • et al.
        Lumbar false aneurysms following image-guided interventive procedures for spondylodiskitic abscesses.
        Skeletal Radiol. 2006; 35: 949-952
        • Kulkarni K.
        • Matravers P.
        • Mehta A.
        • Mitchell A.
        Pseudoaneurysm following vertebral biopsy and treatment with percutaneous thrombin injection.
        Skeletal Radiol. 2007; 36: 1195-1198
        • Groen R.J.M.
        • et al.
        Anatomical and pathological considerations in percutaneous vertebroplasty and kyphoplasty: a reappraisal of the vertebral venous system.
        Spine. 2004; 29: 1465-1471
        • Liu L.
        • et al.
        Iatrogenic lumbar artery injury in spine surgery: a literature review.
        World Neurosurg. 2019; 122: 266-271