Study: Lumbar spine stabilization surgery may be a risk factor in symptomatic venous outflow obstruction lesions

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Lumbar spine stabilization surgery may be a risk factor in the development of symptomatic venous outflow obstruction lesions, a study published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders has found.

Furthermore, writes lead author Peter J. Pappas, MD, et al during venography and stenting in patients with anterior lumbar interbody fusion approaches, “significant scarring may be encountered, resulting in a residual stenosis after stent placement.”

Pappas—of the Center for Vein Restoration and the Center for Vascular Medicine, who is based in Morristown, New Jersey—and colleagues had set out to determine whether there is an association between spine stabilization surgery and the development of symptomatic iliac vein outflow lesions.

The study, entitled “Spine stabilization is a risk factor for the development of pelvic iliac vein lesions,” was a retrospective chart review of prospectively collected data from the team’s electronic medical record system in which the investigators identified patients who underwent venography with or without venous stenting and had a history of previous lumbar spine stabilization. It was funded by a grant from the Lakhanpal Foundation.

“Open lumbar spine stabilization surgery often requires mobilization of the left and right common iliac veins (CIVs) and the placement of plates and screws that can impinge on them,” the authors write. “We reviewed our venography experience of the past three years to determine whether there is an association between spine stabilization surgery and the development of symptomatic iliac vein outflow lesions.”

Patient demographics, medical comorbidities, venograms and intravascular ultrasound (IVUS) data were collected and analyzed. From January 2014 to April 2018, venography was performed in 1,713 limbs in 1,245 patients at the Center for Vascular Medicine. “Of the 1,245 patients, 18 had a history of lumbar spine stabilization procedures: five anterior-posterior and 13 posterior,” they note.

“Nine had single-level and eight had two- or three-level fusions. All 18 patients demonstrated pelvic lesions. These included one left CIV aneurysm, five left CIV stenoses, three bilateral CIV stenoses, two left CIV and inferior vena cava occlusions, and two external iliac vein stenoses. The aneurysm patient was treated with anticoagulation, eight patients underwent stenting, one patient refused stenting because of relocation to another country and one inferior vena cava-CIV occlusion could not be crossed.”

They add: “Lesions in anterior lumbar interbody fusion patients were extremely stenotic, required predilation, and resulted in a residual stenosis requiring venoplasty at a second setting in one patient.”

The researchers conclude: “Predilation venoplasty, before stent deployment, is recommended to prevent stent migration.

“Furthermore, a history of spine stabilization surgery in patients presenting with pelvic symptoms, lower extremity pain or swelling, or post-thrombotic symptoms, should prompt consideration of a pelvic venous duplex ultrasound examination to determine whether an iliac venous outflow lesion is present.”

They provided advice for patients who report under certain circumstances.

“Patients presenting with symptomatic lower extremity pain, swelling and venous stasis skin changes who have a history of a previous lumbar interbody fusion should have a pelvic ultrasound examination to evaluate the iliac veins for a possible iliac venous outflow lesion,” the authors add.

SOURCE: DOI.ORG/10.1016/J. JVSV.2019.08.018

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