High-Output Circulatory Failure Due to Arteriovenous Fistula

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Abstract
High-output circulatory failure is an unusual complication of intervertebral-disk operation. Inadvertent injury of great vessels during the operation may result in the formation of an arteriovenous fistula. Circulatory adjustments to the fistula, with the development of high-output circulatory failure, may prompt the patient to seek medical treatment months after the disk operation, at a time when the causal relationship may not be apparent. Anatomic and surgical features of intervertebral-disk surgery, particularly between the fourth and fifth lumbar vertebrae, predispose to injury of close-lying great vessels. Figure 1 illustrates pertinent anatomy of this area. It is readily appreciated that a small error in placement of a biting instrument, such as the pituitary forceps (the guilty instrument in most cases), might result in injury of the large artery and vein in this area. Laceration of artery alone produces hemorrhage or false-aneurysm formation. Simultaneous injury to artery and vein, however, may result in

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