Abstract
Posterior approach lumbar disc surgeries (LDS) can be associated with serious iatrogenic vascular complications which could be a serious life threatening condition. We report a rare case of right sided acute iliac vessels iatrogenic arteriovenous fistula (IAVF) which was diagnosed and managed in 24 hours duration in a 45 years old healthy female who underwent surgical posterior approach L4-5 discectomy. Intraoperative, she developed sudden hypotension, tachycardia, wide pulse pressure and acute drop of hemoglobin level without obvious operative site bleeding which raise the index of suspicion of vascular injury and urge the team for doing emergency CT angiography (CTA), vascular and endovascular team consultation for digital subtraction angiography (DSA) and endovascular management. Endovascular stenting is nowadays the modality of choice of intervention. We provide case report with literature review.
Highlights
Iatrogenic vascular injuries due to lumbar surgeries constitute about 0.02% 0.06%
We report a rare case of right sided acute iliac vessels iatrogenic arteriovenous fistula (IAVF) which was diagnosed and managed in 24 hours duration in a 45 years old healthy female who underwent surgical posterior approach L4-5 discectomy
Intraoperative, she developed sudden hypotension, tachycardia, wide pulse pressure and acute drop of hemoglobin level without obvious operative site bleeding which raise the index of suspicion of vascular injury and urge the team for doing emergency computed tomography (CT) angiography (CTA), vascular and endovascular team consultation for digital subtraction angiography (DSA) and endovascular management
Summary
Iatrogenic vascular injuries due to lumbar surgeries constitute about 0.02% 0.06%. These injuries could be acute life threatening with rapid progressive deterioration of blood pressure due to retro-peritoneal hemorrhage or presented. Chronic AVF can be diagnosed by history and physical examination findings. Our case report represents the first rare type of acute iatrogenic AVF which is usually presented with acute changes of blood pressure, pulse parameters and rapid lowering of hemoglobin level without evident surgical site bleeding. Detection and rapid resuscitation with definitive endovascular management are lifesaving
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