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Recognition of Unintended Intravascular Injections During CT Fluoroscopy-Guided Spine Procedures 2014

Category Interventional Peter G. Kranz
Jenny Hoang
Linda Gray
Purpose Imaging findings associated with unintended intravascular injection during CT fluoroscopy (CTF) guided procedures would be expected to differ from findings on conventional fluoroscopy due to the cross sectional nature of the imaging guidance, but have not been previously described. The purpose of this investigation was to identify imaging patterns associated with inadvertent intravascular needle placement during CTF-guided spine procedures. Materials & Methods In this retrospective case series, we identified 22 cases of inadvertent intravascular needle placement confirmed during CTF-guided epidural steroid injection or blood patching. Procedure type, approach, and spinal level were recorded. Procedural images were reviewed to assess for the presence of any of the following patterns: local (1 cm) vessel opacification, no contrast visualization due to immediate washout, progressive contrast washout, and simultaneous epidural and intravascular contrast injection. Results Intravascular injections were identified in 10 cervical (45%), 4 thoracic (18%), and 8 lumbar (36%) injections. Transforaminal approach was used for 15/22 (68%) cases; the remainder used an interlaminar approach. The most common imaging patterns were visualization a local vessel only (32%) or visualization of both a local and remote vessel (32%). In 27% of cases, only remote vessel opacification was seen. Although progressive washout of contrast was common (seen in 81% of cases), no contrast visualization due to immediate washout was seen in 9% of cases. Simultaneous epidural and intravascular injection was seen in 23% of cases. In all cases, needle repositioning permitted successful completion of the procedure. There were no adverse clinical outcomes. Conclusion While local vessel opacification with progressive washout of contrast was the most common pattern identified, it is not the exclusive appearance of inadvertent intravascular injection during CTF guided spine injections. Other patterns, including remote vessel opacification without local vessel opacification, and absent opacification following contrast injection were encountered. Proceduralists should be aware of such patterns in order to avoid potentially serious complications. References None