Vascular complications of lumbar disc surgery

Abstract

Over a period of seven years nine patients with vascular complications after lumber discectomy received medical care at the Clinic of Vascular Surgery, University of Graz Medical School. We report five acute bleeding complications occurring during the operation and four late manifestations of vascular lesions. Five patients presented with acute life-threatening iatrogenic haemorrhages from pelvic vessels. Three patients made a complete recovery, one patient died from acute haemorrhagic shock, one further patient died from sepsis due to an associated complication-an injury to the ureter. Over a period of two to ten years after primary surgery we corrected late complications such as 1 case of posttraumatic aneurysm of the aortic bifurcation found to have eroded the body of the fifth lumbar vertebra, and three cases of arteriovenous fistula between the common iliac artery and the common iliac vein. The four cases described below are an attempt to document the vascular surgical procedures involved and to provide typical findings. The risk of injuring the pelvic vessels intra-operatively can be explained by the close anatomical relation between the retroperitoneal vessels and the vertebral column and furthermore not only by the fact that pre-existent deficiencies but also injury to the anterior longitudinal ligament give access to the retroperitoneal space.

The unusual presentation of a vascular injury after lumbar microdiscectomy: case report

“…1,9,23 Although vascular injuries account for less than 1% of complications during these surgeries, 4,5,15,16,29 they are one of the most feared complications and can have devastating consequences, including mortality. [6][7][8]10,13,19 In 1945, Linton and White reported the first case of a vascular injury after lumbar discectomy resulting in AVF formation. 22 Since then, many more cases of vascular injury during lumbar spinal surgery have been documented.…”

“…The most common injury is a vascular tear, 3 and its presentation varies from heavy bleeding to signs of shock including tachycardia and hypotension in the early postoperative period. [4][5][6][7][9][10][11][12][13]15,18,19,28 Other vascular injuries, such as AVFs and pseudoaneurysms, are commonly diagnosed in the late postoperative period. 2 AVF is the second most common type of vascular injury after lumbar spine surgery 3 and can have various presentations.…”

“…Although vascular injuries occur at a low frequency during lumbar spine surgery, they are among the most feared complications due to their potentially life-threatening consequences. 4,[6][7][8]10,13,14,19,21,24,27 Vascular injuries during lumbar spine surgery may involve injury to the arterial blood supply, venous blood supply, or both. Acute lacerations to the arterial blood supply can present in various ways, from massive hemorrhage to small changes in blood pressure, heart rate, and end-tidal CO 2 .…”

“…Many arterial injuries are identified intraoperatively or shortly thereafter. 2,3,7,8,[10][11][12][13]18,19,21,24,26,27,30,33 Venous injuries do not always manifest as acutely and can be missed for years postoperatively. 2,4,5,9,13,15,17,31 Late presentations range from asymptomatic to high-output cardiac failure that causes death from an undiagnosed arteriovenous fistula (AVF).…”

Answer

“…Documented risk factors for these complications include advanced age; female gender; obesity; atheroma at the puncture site; aortic regurgitation; hypertension and the use of aspirin, warfarin or heparin; duration of the procedure; calibre of the sheath and catheters; and multiple arterial punctures. 1,2 Overall, the risk of major vascular complications after cardiac catheterization is low. 3 In a review of 7333 patients who underwent percutaneous femoral cardiac interventions, 1% of these patients underwent operative repair of catheterization-related complications.…”