Hybrid approach for removal of an errant intra-vascular pedicle spinal fixation screw in the thoracic aorta.

Overview

Late presentation of aortic injuries secondary to internal fixation hardware is uncommon and generally associated with pseudoaneurysm formation. We herein present a case of transmural migration of a pedicle screw into the descending thoracic aorta, which was revealed incidentally by computed tomography scan after almost 4 years of hardware implantation. Approximately 75% of the pedicle screw was exposed to the bloodstream, and was successfully removed using endovascular segmental exclusion to avoid aortic cross-clamping and an open approach via left thoracotomy. This case illustrates the successful repair of an iatrogenic aortic injury using a hybrid technique.