Endovascular Management of a Chronic Iliac Arteriovenous Fistula Following Lumbar Discectomy

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Vascular injuries following lumbar disc surgery are relatively rare but potentially life-threatening complications. While the first report of such an injury appeared in 1945, a recent review identified close to 100 such cases in the last 40 years. Several types of injuries are described including lacerations and pseudoaneurysms with arteriovenous fistulae occurring most commonly in two thirds of cases. These fistulae may result in leg swelling, ascites, heart failure, valvular dysfunction or can be completely asymptomatic. Although most of these have been recognized shortly after spinal surgery there are reports of these complications eluding correct diagnosis for many years. Until the mid 1990s the only option for repair of these fistulae was with open surgical techniques. These attempts at repair were often complicated with significant haemorrhage and resulted in surgical mortality rates of up to 34%. With the introduction of endovascular techniques a less invasive alternative was developed with fewer risks of intraoperative haemorrhage and mortality. The following report describes a patient with an arteriovenous fistula following lumbar discectomy that, despite being increasingly symptomatic, was not recognized until 8 years following the initial surgery. The fistula was successfully treated with a two stage endovascular approach.