[Vascular complications of lumbar disk surgery. Report of two cases and review of the literature on 122 cases].
We report two cases of right lumbar common iliac arteriovenous injury after an operation on the L4-L5 disk. One case was an arteriovenous fistula disclosed 5 years after the operation and in the other case, a postoperative acute haemorrhage. A retrospective study is carried out in the literature aiming at establishing the frequency of vascular injury in lumbar disk surgery, their nosologic definition, and the provided treatment. One hundred and twenty two observations were taken into account. The frequency cannot be determined. 78 of these observations (63.9%) reported an arteriovenous fistula between two elements of the aortic-cava intersection, with acute revelation (6.4%), sub-acute (19%) or late as a right cardiac failure (64%). Thirty one cases of acute haemorrhages through isolated arterial wound (25.4%), 3 cases of arterial or venous thrombosis (2.5%) and 10 cases of false aneurysms (8.2%) were found. The treatment was always surgical, sometimes in high emergency. In the case of haemorrhage the death rate was 21% and in the event of fistula 1.3%. Morbidity was 11.5%, mostly due to a post-phlebitic syndrome. These results reduce the mildness reputation of lumbar disk surgery all the more as recording of the complications is under estimated and most of them are found far from the initial act.
Service de Chirurgie Cardio-Vascularie et Thoracique, CHU Brest.
J C
JC
Pillet
M C
MC
Pillet
J
J
Braesco
E
E
Thomas
E
E
Bezon
P H
PH
Mondine
J A
JA
Barra
J
J
Pillet
D000328:Adult; D001164:Arteriovenous Fistula / Q000209:etiology*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000293:injuries; D007084:Iliac Vein / Q000293:injuries; D007403:Intervertebral Disc / Q000601:surgery*; D008161:Lumbosacral Region; D008875:Middle Aged; D011183:Postoperative Complications; D014682:Vena Cava, Inferior / Q000293:injuries
Complications vasculaires de la chirurgie discale lombaire. A propos de deux cas et d'une revue de littérature de 122 cas.