Intraoperative Thrombolysis of Massive Pulmonary Embolus During Spine Surgery: Case Report of Survival Complicated by Massive Bleeding and Review of the Literature
| Autor: | Galina Leyvi, John K. Houten, Shahenaz Elsamragy, Jinu Kim, Merritt D. Kinon, Ryan Holland |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Hemorrhage 03 medical and health sciences Intraoperative Period 0302 clinical medicine Epidural hematoma Lumbar Fibrinolytic Agents medicine Paralysis Thrombolytic Agent Humans Thrombolytic Therapy Aged business.industry Thrombolysis medicine.disease Pulmonary embolism Surgery Prone position Spinal Fusion Embolism 030220 oncology & carcinogenesis Tissue Plasminogen Activator Female Neurology (clinical) medicine.symptom business Pulmonary Embolism 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. 146 |
| ISSN: | 1878-8769 |
| Popis: | Background Pulmonary embolism (PE) is a known risk of lumbar spinal fusion surgery that can lead to sudden and unexpected death. Treatment often involves systemic anticoagulation when the risk of potentially fatal hemodynamic deterioration is judged to outweigh the risk of epidural hematoma and paralysis. Acute massive PE with obstruction of more than 50% of the pulmonary arterial tree causes right heart failure, hypotension, and often rapid death, and may require aggressive medical intervention with thrombolytic agents, such as alteplase, although in the postoperative period this entails an extremely high risk of bleeding and the associated potential neurologic morbidity. Case Description We report the first case, to our knowledge, of intraoperative thrombolytic therapy during spine surgery in a 68-year-old woman who developed a massive PE with cardiac arrest while undergoing lumbar instrumented fusion surgery in the prone position and detail the postoperative course that was complicated by severe bleeding. Conclusions Our experience is that chemical thrombolysis can be a lifesaving option to address pending circulatory arrest, but that severe bleeding is a likely consequence. If used to treat an intraoperative emergency, a smaller than standard dose of thrombolytic should be considered. |
| Databáze: | OpenAIRE |
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