Vascular rescue–minimally invasive management of a post-spinal surgery fistulized ilio-iliac pseudoaneurysm: a case report

Abstract

BackgroundAortoiliac injury after intervertebral disc surgery is an uncommon but potentially fatal complication. This case study emphasizes how crucial it is to identify this uncommon complication, which can manifest itself in a variety of ways, including leg oedema, heart failure, and deep vein thrombosis. This case is unique in that it presents with an uncommon post-spinal surgery complication of fistulized pseudoaneurysm of the common iliac artery and vein. This combination calls for an immediate diagnosis and careful care.Case presentationA 36-year-old female patient presented with progressively worsening orthopnea, accompanied by chest pain and palpitations. Her medical history revealed gradually increasing right lower limb swelling since three months, following a discectomy procedure for the management of lower back pain associated with a herniated lumbar disc at the L5-S1 level. Doppler ultrasonography demonstrated an arterialized flow within the right common iliac vein. Subsequent computed tomography angiography identified a pseudoaneurysm of the right common iliac artery, which had formed a fistulous connection to the right common iliac vein. This uncommon complication was likely attributable to prior disc surgery. The patient received endovascular intervention, which was executed in two primary stages: first, embolization of the right internal iliac artery was performed, followed by the exclusion of the arteriovenous fistula through the deployment of a covered stent graft within the right common iliac artery. The intervention successfully resolved both the pseudoaneurysm and the arteriovenous fistula.ConclusionsThis case report underscores the importance of considering vascular complications in patients presenting with unusual symptoms following intervertebral disc surgery, even after a significant time lapse. While both open surgical and endovascular approaches can yield good results in treating such complications, the endovascular method, as demonstrated in this case, is associated with minimal morbidity. This approach offers a less invasive alternative that can effectively manage complex vascular injuries resulting from disc surgery. Clinicians should be aware of this rare but serious complication to ensure timely diagnosis and appropriate management, potentially improving patient outcomes in similar cases.