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Iatrogenic Iliac Vein Compression From Anterior Lumbar Interbody Fusion
Mennatalla Hegazi, Nishant Sharma, Samuel Chen, Isabella Kuo, Nii-Kabu Kabutey, Roy Fujitani, Anthony Chau;
University of California, Irvine, Orange, CA, USA

OBJECTIVES: Anterior lumbar interbody fusion (ALIF) has been adopted by orthopedic and neurosurgeons as an approach to minimize the need for retraction of the paraspinal muscles. A multidisciplinary team is needed for its success, and vascular surgeons play a pivotal role in assisting with surgical exposure. We aimed to review complications, including incidence of iatrogenic iliac vein compression that occur during ALIF.
METHODS: A retrospective review was performed at a single tertiary care center to identify patients who had undergone ALIF from 2014-2021. Complications following surgery were identified. RESULTS: Eight-five patients were identified (37 female and 34 male, mean age 63.5years). 5 patients (5.9%) required post-operative transfusions ranging from 2 to 10 units of packed red blood cells. 3 patients (3.5%) were found to have iatrogenic iliac vein compression syndrome (IVCS) requiring endovascular intervention with left common iliac vein (LCIV) stenting. Time to diagnosis of IVCS ranged from three months to over two years. The presenting symptom of all 3 patients was left lower extremity swelling. Notably, one patient had significant bleeding from the LCIV requiring repair at the index operation and brief chest compressions with successful return of circulation. 3 patients had readmissions within 30-days with return to the operating room for wound debridement. There were also singular incidents of the following complications: pneumonia, urinary tract infection, myocardial infarction, organ space infection, and deep venous thrombosis. Collectively, patients who had subsequent complications were more likely to have a longer duration of index operation (415 vs 242 minutes, p<0.001) and greater blood loss (381 vs 206 mL, p<0.05). CONCLUSIONS:While ALIF can be safely performed, complications from surgery can be wide ranging and present years later. Both thrombotic and non-thrombotic iliac vein compression can present late and should be considered during follow-up.
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