A Case of Iatrogenic Iliac Arteriovenous Fistula Evident 23-years after Lumbar Laminectomy

Abstract

We report a case of high output heart failure due to an iatrogenic iliac arteriovenous fistula which becomes evident 23-years after lumbar laminectomy. A 47-year-old man consulted a general physician complaining of palpitation and dyspnea on effort. Chest X-ray and ECG demonstrated cardiac enlargement, pleural effusion, and atrial fibrillation.

Hew as referred to a department of cardiology in our hospital. The previous clinical history was completely unremarkable except for a lumbar discectomy at L4-L5 performed 23 years previously. Operative record show that abnormal bleeding through the intervertebral space and severe hypotension was observed during the operation. Examination revealed continuous bruit throughout the right lower abdomen. Angiography demonstrated an enlarged right cavity and inferior vena cava, and an AV fistula arising at the bifurcation of the right common iliac artery, communicating with the right common iliac vein. Contrast enhanced CT confirmed these findings and demonstrated pseudoaneurysmal formation of right common iliac artery. We elected to manage this fistula with an open surgical procedure. At surgery,th e right iliac AVF was ligated and excluded, and straight 8 mm Dacron graft was inserted to substitute for the distal abdominal aorta and the proximal external iliac arteries. Operative findings revealed severe adhesion around the aortic bifurcation. The patient was completely asymptomatic postoperatively, although postoperateive CT scan revealed the remnant AVF. Hew as discharged in good clinical condition 10 days after surgery.