title: Vascular complications in lumbar disk surgery: report of four cases.
abstract: Vascular injuries in lumbar disk surgery, although rare, are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important that surgeons and radiologists be aware of these potentially fatal complications and develop an appropriate symptom-based diagnostic paradigm. We reviewed 8099 consecutive cases of lumbar disk surgery, performed over a 14-year period at a single institution, for postoperative vascular complications. We identified four patients (0.05%) with lumbar disk surgery-related vascular complications: intraoperative lacerations of the abdominal aorta and median sacral artery, an arteriovenous fistula between the left common iliac artery and vein detected 19 days postdiskectomy, and a partially thrombosed aortic aneurysm with an arteriovenous fistula between the aneurysm and the inferior vena cava, diagnosed 11 months after surgery. The majority of cases in the literature of vascular injury in lumbar disk surgery were reported prior to 1965. Diagnostic approaches described in that period do not reflect the great range of diagnostic techniques available today. Angiography remains the gold standard for diagnosis and guidance as to surgical repair. However, a high index of suspicion based on clinical signs and/or the use of sonography or CT is important in the detection of these complications.
authors.affiliation: Department of Radiology, University of California San Francisco 94143-0628, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Szolar
authors.forename: K W
authors.initials: KW
authors.lastname: Preidler
authors.forename: H
authors.initials: H
authors.lastname: Steiner
authors.forename: T
authors.initials: T
authors.lastname: Riepl
authors.forename: G
authors.initials: G
authors.lastname: Flaschka
authors.forename: M
authors.initials: M
authors.lastname: Stiskal
authors.forename: S
authors.initials: S
authors.lastname: Moelleken
authors.forename: D
authors.initials: D
authors.lastname: Norman
mesh_terms: D000368:Aged; D000792:Angiography; D001012:Aorta, Abdominal / Q000293:injuries* / Q000473:pathology; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000601:surgery; D001158:Arteries / Q000293:injuries; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000601:surgery; D003952:Diagnostic Imaging; D017586:Diskectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000293:injuries* / Q000473:pathology; D007084:Iliac Vein / Q000293:injuries* / Q000473:pathology; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012447:Sacrum / Q000098:blood supply; D014682:Vena Cava, Inferior / Q000293:injuries* / Q000473:pathology