Prone thoracic endovascular aortic repair via the popliteal artery for inadvertent vascular injury during spondylectomy: a case report

BACKGROUND: Vascular injury during spinal surgery is a dreaded complication associated with high morbidity and mortality. Repositioning the patient following such an injury could result in significant time delays and haemorrhage. Endovascular repair via popliteal access has never previously been described in the literature. A novel prone thoracic endovascular aortic repair (TEVAR) technique is described here as a safe alternative to manage vascular injury during posterior spinal surgery. CASE DESCRIPTION: Here we describe a 63-year-old male where endovascular repair of vascular injury to the aorta by intercostal artery avulsion was performed via popliteal artery access in the prone position during T11 en bloc spondylectomy and posterior fusion. The patient remained haemodynamically unstable following the vascular injury precluding immediate transfer to the angiography suite. Identification of vascular injury to deployment of TEVAR graft was 90 minutes. The spondylectomy was able to be completed without repositioning the patient. Radiological and clinical follow-up revealed no complications at 1 and 2 months respectively following surgery. CONCLUSIONS: TEVAR placement via this novel popliteal access route was able to halt the haemorrhage allowing stabilisation of the patient and completion of the spinal procedure. Clinical teams should be made aware this is a viable technique to address vascular injuries during spinal surgery.