gms | German Medical Science

Objective: Vascular injuries during lumbar spine surgery may involve injury of the large intraabdominal arterial blood vessels, venous vessels, or both. Most arterial injuries are identified intraoperatively or shortly thereafter. Venous injuries do not always manifest as acutely and can be missed for years postoperatively. In this report, we present the case of a patient with arteriovenous fistula as a clinically manifest complication two weeks after of lumbar disc surgery.

Methods: Case Report

Results: A 52-year-old woman was admitted to our hospital with low back pain, left leg pain, and weakness of left leg. Body mass index was 35.3 kg/m2. Her medical history included a laparotomy and hysterectomy 10 years before. The MRI scans demonstrated a left-sided disc herniation with nerve root compression L4-5. A microdiscectomy in prone position was performed. Postoperatively the woman was discharged on postoperative day 5. Fifteen days after microdiscectomy the woman was readmitted to hospital with dyspnea, chest pain, and fatigue. Chest X-ray showed bilateral pleura effusions and a pulmonary vascular congestion. Abdomen sonography was without pathological findings. Physical examination and echocardiography showed high output heart failure. Relevant laboratory findings included a haemolytic anaemia and a brain natriuretic peptide of 2426 pg/ml. Twenty-four days after microdiscectomy, a contrast-enhanced CT showed an arteriovenous fistula between right common iliac artery and inferior vena cava. Three days later, through a percutaneous right and left common femoral artery approach, two GORE VIABAHN endoprosthesis (labeled diameter 13 mm, length 50 mm; W. L. Gore & Associates, Inc.) were placed in each common iliac artery systems in kissing position. Patient symptoms of dyspnea, chest pain, and fatigue completely recovered. The color-coded duplex sonography on day 4 and 7 after the endovascular intervention showed closure of the arteriovenous fistula. Eight days after the endovascular intervention the woman was discharged home.

Conclusion: The incidence of vascular injury in association with lumbar disc surgery is less than 0.1 %. Early diagnosis and treatment of vascular complications following disc surgery is essential due to their high mortality rates. The use of minimally invasive interventional techniques is simple and quick in the management of vascular injuries following spine surgery. Subacute arteriovenous fistula following spine surgery can be treated with surgical or endovascular procedures.