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NEUROSURGICAL ANESTHESIA

Iatrogenic Arteriovenous Fistula During Lumbar Microdiscectomy

Senthilkumar Sadhasivam, MD^*, and A. Murat Kaynar, MD

*Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania; and Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston

Address correspondence and reprint request A. Murat Kaynar, MD, Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215. Address e-mail to mkaynar{at}bidmc.harvard.edu

Vascular lacerations, arteriovenous fistulae, and pseudoaneurysms are rare, but potentially life threatening, complications of lumbar disk surgery. These iatrogenic vascular injuries may present with significant hypotension during the perioperative period. Early diagnosis and surgical repair may decrease morbidity and mortality. We discuss perioperative implications of postdiscectomy vascular injuries in this report.

IMPLICATIONS: Iatrogenic vascular injuries after lumbar disk surgery are rare but potentially life threatening. Such injuries may perioperatively present in a diverse array of manifestations, and often the diagnosis is delayed or overlooked, which may increase morbidity and mortality. Early diagnosis and surgical repair of these vascular injuries can be life saving.