Arteriovenous Fistula and Isolated Vascular Injuries Secondary to Intervertebral Disk Surgery

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Abstract
Two cases of isolated vascular injury and 2 of arteriovenous fistula resulting from intervertebral disk operation are reported. The literature is reviewed, with tabulation of 25 cases of arteriovenous fistula reported to March 1963. The gravity of this complication is demonstrated by a mortality rate of over 50%. Preventive measures are not available; however, awareness can result in early and effective treatment. When isolated arterial injury is suspected, laparotomy with arrest of the bleeding should be performed immediately. Diagnosis of arteriovenous fistula is not difficult. Auscultation of the abdomen and lumbar area in patients who had disk operations would eliminate high output heart failure in practically every instance. When unexplained cardiomegaly with or without heart failure occurs, or unilateral thrombophlebitis with or without tortuous veins, arteriovenous fistula must be ruled out. Treatment for arteriovenous fistula is restoration of arterial continuity, either by simple division of the fistula with arteriorrhaphy and venorrhaphy or by placement of a graft. The operative mortality rate in this review was 4%.