Large vessel injury following operation for a herniated lumbar disc.
Major vascular injury can occur during an operation for a herniated lumbar disc due to the intimate anatomical relation between the lumbar vertebrae and major vessels. Although occurrence is infrequent, it is associated with high morbidity and mortality. Diagnosis is suspected when early signs of retroperitoneal hemorrhage appear, but may often be delayed for weeks or years. Formation of a pseudoaneurysm or an arteriovenous (A-V) fistula may be of gradual onset and produce initially only a few symptoms. We report here six cases of large vessel injury, which consisted of active bleeding from an injured common iliac artery, or a pseudoaneurysm of the common iliac artery with or without an A-V fistula that occurred following an operation for a herniated lumbar disc and was successfully treated by radiologic intervention and/or surgery. Angiography with the intention of intervention is considered the first step of treatment for a large vessel injury following an operation for a herniated lumbar disc at the level between fourth and fifth lumbar or between fifth lumbar and first sacral intervertebral space.
Kwon
Tae-Won
TW
Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. twkwon2@amc.seoul.kr
Sung
Kyu-Bo
KB
Cho
Yong-Pil
YP
Kim
Do-Kyun
DK
Ko
Gi-Young
GY
Yoon
Hyun-Ki
HK
Kim
Geun-Eun
GE
D000328:Adult; D017541:Aneurysm, False / Q000209:etiology / Q000628:therapy; D001164:Arteriovenous Fistula / Q000209:etiology / Q000628:therapy; D017586:Diskectomy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D007083:Iliac Artery / Q000293:injuries*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D015641:Radiography, Interventional; D012189:Retrospective Studies