Abstract
Iatrogenic vascular complications resulting from lumbar disc surgery are uncommon but serious problems in vascular surgery and their clinical manifestations vary, from fatal retroperitoneal hemorrhage which requires an immediate laparotomy, to late consequences including false aneurysm and arteriovenous (AV) fistula. Since Linton and White presented the first case of an AV fistula after lumbar disc surgery in 1945, it has been well recognized as a late complication of this type of surgery and is diagnosed by the manifestation of high-output congestive heart failure late after the procedure. We encountered a case of an iliac AV fistula treated by endovascular procedure 21 years after lumbar disc surgery. A 45-year-old woman consulted a general practitioner complaining of general malaise. On physical examination we detected a bruit in her right lower abdomen. Her clinical history was completely unremarkable except for a laminectomy of the L4–L5 vertebrae at age 24. A clinical examination demonstrated a pansystolic murmur audible in the periumbilical area, but without any evidence of leg edema. A chest X-ray firm demonstrated moderate cardiomegaly with 53% cardiothoracic ratio. Abdominal enhanced computed tomography scans revealed a hyperdense image of the inferior vena cava and irregular dilatation of the left common iliac vein and abdominal aortography showed a high-flow fistula between the right common iliac artery and the inferior vena cava. A hand-made stent graft was formed using a self-expanding spiral Z stent which was successfully deployed in the right common iliac artery, sealing the orifice of the AV fistula. Recently, less invasive endovascular techniques can help avoid the risk of substantial blood loss perioperatively. However, the durability of endoprostheses is unknown, and long-term studies are needed to confirm the efficacy of endovascular procedures for iatrogenic vascular complications.
