Dorobat B, Musa A, Radu RA. Abdominal aortic pseudoaneurysm as a complication of percutaneous vertebroplasty: A case report. World J Clin Cases 2026; 14(25): 125804 [DOI: 10.12998/wjcc.125804]
Corresponding Author of This Article
Bogdan Dorobat, MD, Consultant Interventional Radiologist, Department of Interventional Radiology, The University Hospital of Bucharest, Splaiul Independentei nr. 169, Sector 5, Bucharest 050098, Romania. Bdorobat@gmail.com
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Radiology, Nuclear Medicine & Medical Imaging
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case-report
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Dorobat B, Musa A, Radu RA. Abdominal aortic pseudoaneurysm as a complication of percutaneous vertebroplasty: A case report. World J Clin Cases 2026; 14(25): 125804 [DOI: 10.12998/wjcc.125804]
World J Clin Cases. Sep 6, 2026; 14(25): 125804 Published online Sep 6, 2026. doi: 10.12998/wjcc.125804
Abdominal aortic pseudoaneurysm as a complication of percutaneous vertebroplasty: A case report
Bogdan Dorobat, Amir Musa, Razvan Alexandru Radu
Bogdan Dorobat, Amir Musa, Razvan Alexandru Radu, Department of Interventional Radiology, University Emergency Hospital of Bucharest, Bucharest 050098, Romania
Author contributions: Dorobat B was the primary operator of the procedure, provided supervision and oversight throughout the study, and served as the guarantor of the work; Musa A was responsible for data acquisition, image collection, and drafting of the manuscript and served as the second operator during the interventional procedure; Radu RA critically reviewed and edited the manuscript for important intellectual content; and all authors have read and approved the final manuscript.
AI contribution statement: AI was used as an assistive tool during manuscript preparation for verification of formatting against the journal’s checklist.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Bogdan Dorobat, MD, Consultant Interventional Radiologist, Department of Interventional Radiology, The University Hospital of Bucharest, Splaiul Independentei nr. 169, Sector 5, Bucharest 050098, Romania. Bdorobat@gmail.com
Received: July 17, 2026 Revised: August 2, 2026 Accepted: August 21, 2026 Published online: September 6, 2026 Processing time: 48 Days and 21 Hours
Abstract
BACKGROUND
Percutaneous vertebroplasty is a widely used treatment for painful vertebral compression fractures. Cement leakage and infection are the most common complications, whereas vascular injury, particularly aortic puncture, is exceedingly rare but potentially fatal. Reports of major vascular injury during vertebroplasty remain scarce, and awareness of this complication remains limited among proceduralists. This case report describes an aortic pseudoaneurysm caused by inadvertent needle puncture during vertebroplasty, highlighting the recognition, endovascular management, and prevention of this complication.
CASE SUMMARY
A 74-year-old female with severe osteoporosis and prior vertebral compression fractures (L3 and L4) underwent percutaneous vertebroplasty for back pain refractory to conservative therapy. During needle advancement at L3, the needle inadvertently traversed the vertebral body, and retrograde blood flow through the needle prompted reflexive withdrawal. Cement injection was subsequently performed at the same level, and anterior cement extravasation was observed on lateral fluoroscopy during injection. Computed tomography angiography revealed a pseudoaneurysm of the infrarenal abdominal aorta with an associated retroperitoneal hematoma, and the hemoglobin level decreased from 12.8 g/dL to 9.6 g/dL. Urgent aortic angiography confirmed the pseudoaneurysm, which was successfully excluded with an endovascular stent-graft. The patient recovered uneventfully, and 6-month computed tomography angiography confirmed stable stent positioning without endoleak, thrombosis, or migration.
CONCLUSION
Aortic injury is a rare but life-threatening complication of vertebroplasty requiring continuous fluoroscopic monitoring throughout the procedure and prompt management.
Core Tip: Aortic injury during percutaneous vertebroplasty is an extremely rare but potentially fatal complication. We report a case of inadvertent anterior cortical breach during needle advancement, resulting in infrarenal aortic puncture, pseudoaneurysm formation, and retroperitoneal hematoma. This complication was recognized by retrograde blood flow through the needle and confirmed by computed tomography angiography. Endovascular stent-graft placement successfully achieved complete exclusion of the pseudoaneurysm, with stable findings at 6-month follow-up. This case highlights the importance of continuous fluoroscopic depth monitoring, maintaining a strict midline needle trajectory, and ensuring immediate access to vascular intervention, particularly in patients with severe osteoporosis.
