Case Report Thoracic Aortic Injury: Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation Konstantinos Lagios, 1 Georgios Karaolanis, 2 Theodossios Perdikides, 2 Theodoros Bazinas, 1 Nikolaos Kouris, 3 Spiros Sfikas, 1 and Odysseas Paxinos 4 1 Interventional Radiology and Neuroradiology Department, 251 Hellenic Air Force Hospital, Athens, Greece 2 Vascular Surgery Department, 251 Hellenic Air Force Hospital, Athens, Greece 3 Anesthesiology Department, 251 Hellenic Air Force Hospital, Athens, Greece 4 Orthopaedic Department, 251 Hellenic Air Force Hospital, Athens, Greece Correspondence should be addressed to Georgios Karaolanis; drgikaraolanis@gmail.com Received 22 February 2015; Revised 26 April 2015; Accepted 27 April 2015 Academic Editor: Paolo Vanelli Copyright © 2015 Konstantinos Lagios et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Iatrogenic aortic injuries are rare and well-recognized complications of a variety of procedures, including spinal surgery. Te placement of pedicle screws is sometimes associated with devastating consequences. Aortic perforation with rapid hematoma formation and delayed aortic trauma leading to pseudoaneurysm formation have been described in the literature. A case describing a signifcant time interval between iatrogenic aortic injury and diagnosis in the absence of pseudoaneurysm formation is described in this paper and, according to our knowledge, is unique in the literature. Te aortic injury was successfully treated, selecting the appropriate graf and, as a consequence, normal spinal cord blood fow was achieved. 1. Introduction Iatrogenic aortic injuries are rare and well-recognized com- plications of a variety of procedures, including spinal surgery [1]. Vaccaro et al. have reported that placing pedicle screws in the thoracic spine exposes the patient to the risk of major vascular injury [2]. On the one hand, aortic perforation is frequently associated either with hemodynamic instability, due to acute hemorrhage, or with rapid hematoma formation, or both. On the other hand, delayed aortic trauma can evolve into pseudoaneurysm formation due to weakness in the aor- tic wall. Diferent invasive strategies, of which endovascular approaches with the use of stents are the dominant, are available for the protection from life-threatening bleeding due to the removal of pedicle screws [3]. Tis paper presents a case of uncommon thoracic aortic injury at the orifce of tenth (T10) intercostal artery, caused by a misplaced pedicle screw, which has been successfully treated using an endovascular procedure. 2. Case Presentation A 22-year-old woman was admitted to our hospital complain- ing of acute thoracic pain. She had undergone a corrective spinal surgery six years ago because of idiopathic scoliosis. Te surgical approach was performed through the posterior thoracolumbar spine. Te instrumentation consisted of two rods fxed by pedicle screws from T10 to L4. Te procedure was well tolerated and the patient had an uneventful post- operative period. She also mentioned an episode of acute abdominal pain four years ago treated in another hospital. Abdominal radiography and laboratory fndings were then negative. She mentioned no other comorbidities. On examination, she was hemodynamically stable. A con- trast-enhanced computed tomography angiography (CTA) revealed a malpositioned pedicle screw and subsequently evaluated the status of the aortic tree (Figure 1). Moreover, digital angiography was performed to evaluate the correlation between the injured segment and the intercostal artery, as Hindawi Publishing Corporation Case Reports in Vascular Medicine Volume 2015, Article ID 531201, 4 pages http://dx.doi.org/10.1155/2015/531201