Vascular complications related to lumbar disc surgery

Abstract

Object. Vascular complications related to lumbar disc operations are rare but extremely fatal conditions. The authors analyzed data retrospectively obtained in 13 patients with vascular complications that occurred during lumbar disc operations performed between January 1990 and January 2002. Methods. One patient underwent an L5—S1 procedure and the remaining underwent L4–5 surgery. Missed injuries, which were found during the late postoperative period, included pseudoaneurysm in four cases and an arteriovenous fistula in one. In all cases except one in which complication occurred early in the postoperative period, the retroperitoneal area was reached via a transperitoneal approach. In eight patients with complications occurring early in the postoperative period, Dacron graft was placed in four with arterial injuries and saphenous vein graft in one. In three cases of arterial injury and five of venous injury, the lesion was repaired using the primer suture technique. The most commonly affected vessels were left common iliac arteries (76.9%) and left common iliac vein (30.8%). In eight early cases, shock or preshock due to hemorrhage developed during the early phase. During the late postoperative period, graft-related infection occurred in two cases in which Dacron graft was placed, and axillofemoral extraanatomical bypass surgery was later performed. There was no surgery-related death. During a mean follow-up period of 5.6 years, none of the patients suffered any problems related to vascular injury. Conclusions. Despite its low incidence, iatrogenic vascular injury related to lumbar disc surgery is a possible complication. During lumbar disc operations early diagnosis of vascular injuries and urgent transperitoneal surgery can save patients' lives.