Microsurgical removal of a misplaced intraspinal venous stent in a patient with inferior vena cava atresia

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Inferior vena cava atresia (IVCA) is a rare vascular condition that may be treated by venous stenting. The authors report on the microsurgical removal of an intraspinally misplaced stent causing nerve root compression and neurological deficits.

A 42-year-old patient with IVCA and painful cutaneous collaterals had been scheduled for treatment by stenting of the iliocaval confluence and associated venous collaterals. Initial stenting of the right iliac vein was successful; however, during recanalization of the left paravertebral plexus, the stent entered the spinal canal via extraspinal-to-intraspinal venous collaterals. Because of the use of monoplanar angiography, the stent misplacement was not seen during the procedure. Postinterventionally, the patient experienced a foot elevation weakness (grade 1/5) as well as pain and hypesthesia corresponding to the L5 dermatome. Ultrasonography ruled out a lumbosacral plexus hematoma. CT angiography showed that a stent had entered the spinal canal through the left S1 neuroforamen causing nerve root compression. The intraspinal portion of the stent was removed piecemeal via a left-sided hemilaminectomy. Venous bleeding due to the patient’s anticoagulation therapy, the stent’s sharp mesh wire architecture, and the proximity to nerve roots complicated the surgery. Postoperatively, the foot elevation improved to grade 4/5.

ABBREVIATIONS ASA = acetylsalicylic acid; CTA = CT angiography; DVT = deep venous thrombosis; IVCA = inferior vena cava atresia.
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Contributor Notes

Correspondence Christoph Schwartz: Helsinki University Hospital, Helsinki, Finland. ext-christoph.schwartz@hus.fi; c.schwartz@salk.at.INCLUDE WHEN CITING Published online January 17, 2020; DOI: 10.3171/2019.11.SPINE191220.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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