J Korean Med Sci.  2013 Jan;28(1):167-169. 10.3346/jkms.2013.28.1.167.

Subacute Course of Common Iliac Arterial Laceration in Lumbar Disc Surgery

• Choi YS
• Chung YS
• Sim KB

• KMID: 2158019
• DOI: http://doi.org/10.3346/jkms.2013.28.1.167

Abstract

Vascular injuries in lumbar disc surgery are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important to be aware of the perioperative implications of this rare occurrence to lower mortality risk. A 20-yr-old man with a right L4-5 lumbar disc protrusion was operated on routinely under a surgical microscope. A bloody surgical field was noted temporarily during a discectomy along with a decreased blood pressure. After fluid resuscitation with an ephedrine injection, the bleeding soon stopped spontaneously and his vital signs were stabilized. Fifty hours after the operation, the patient showed signs of hypovolemic hypotension with abdominal distension. The right femoral artery pulsation was absent on palpation. An enhanced CT angiography revealed a retroperitoneal hematoma and obstruction of the left common iliac artery. An urgent laparotomy was done to repair the injured vessel by excision and interposition of a graft. The patient had an uneventful recovery.The subacute course of deterioration might have been due to intermittent blood leakage from the lacerated common iliac artery, which was sealed spontaneously. It is very important to pay close attention to post-surgical clinical manifestations to avoid a potentially fatal outcome in lumbar disc surgery.

Keyword

Lumbar Disc Surgery; Common Iliac Artery Laceration; Subacute Course

MeSH Terms

Angiography
Diskectomy/*adverse effects
Hematoma/etiology
Humans
Iliac Artery/*injuries
Intervertebral Disc
Lacerations/*etiology
Lumbar Vertebrae/*surgery
Male
Tomography, X-Ray Computed
Young Adult

Figure

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  Fig. 1 Enhanced CT showed non-enhancing thrombotic obstruction of the left common iliac artery iliac artery (arrow) and accompanied large retroperitoneal hematoma (arrowheads). These findings suggested the possibility of iatrogenic arterial laceration with dissecting arterial occlusion and periarterial hematoma formation.

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  Fig. 2 Pelvic angiography showed short segmental abrupt arterial obstruction in the left common iliac artery (arrows), suggestive of arterial dissection with occlusion. There is reconstitution of the left internal and external iliac arteries (arrowheads) through pelvic collateral pathways.

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