An Iliac Arteriovenous Fistula and Pseudoaneurysm after Lumbar Disc Surgery.

Jeong, Chul An; Park, Kwan Ho; Jo, Yun Gu

Case Report

Journal of Korean Neurosurgical Society 2004;36(5): 415-418.

¹Department of Neurosurgery, Seoul Veterans Hospital, Seoul, Korea. spineho@hanmail.net
²Department of Radiology, Seoul Veterans Hospital, Seoul, Korea.

ABSTRACT

Lumbar disc surgery is a common operation with rare vascular complications. The authors report a case of iliac arteriovenous(AV) fistula and pseudoaneurysm as a complication of lumbar disc surgery. A 52-year-old man underwent lumbar disc surgery 14 months prior to the admission. His chief complaints were progressive pain and swelling on the left lower limb. Contrast medium enhanced computed tomography(CT) scan showed dilatation in both iliac veins, right iliac AV fistula, and an pseudoaneurysm. Angiogram demonstrated a pseudoaneurysm originated from the right common iliac artery, associated left iliac vein compression, and dilatation in both iliac veins. The patient was treated with an endovascular stent placement. Angiogram obtained after stent grafting demonstrated elimination of the pseudoaneurysm, occlusion of the AV fistula, and right iliac artery patency. One month after the stent placement, his leg pain and swelling were improved markedly. A high suspicion based on clinical signs, CT scan, and angiography are important in the early detection of AV fistula. An endovascular stent placement is considered a promising treatment in select patients with iliac AV fistulae and pseudoaneurysms.

Key Words: Arteriovenous fistula; Pseudoaneurysm; Lumbar disc surgery; Angiography; Stent