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David C. Brewster, MD; Andrew R. L. May, FRCS; R. Clement Darling, MD; William M. Abbott, MD; Ashby C. Moncure, MD

Arch Surg. 1979;114(9):1026-1030.

Abstract
• Major vascular injury is an unusual but well-recognized complication of lumbar disk surgery. Clinical manifestation of such injuries may be extremely variable. Isolated arterial laceration is most common, with early manifestation due to retroperitoneal hemorrhage. There are often few external signs of blood loss, however, and the diagnosis may not be recognized initially. Formation of an arteriovenous fistula or false aneurysm produces even fewer early signs, and diagnosis is often delayed for weeks or years. Six cases are described that illustrate the full spectrum of acute and chronic manifestations of such injuries. Two cases of acute hemorrhage due to arterial trauma were seen; one case was recognized intraoperatively and one in the recovery room. In four cases arteriovenous fistulae developed and were diagnosed from eight hours to eight years postoperatively. Two cases also had associated false aneurysms, one the probable source of pulmonary emboli and one the principal manifestation of the vascular injury.

(Arch Surg 114:1026-1030, 1979)

Author Affiliations
From the General Surgical Services, Massachusetts General Hospital, and the Department of Surgery, Harvard Medical School, Boston. Dr May is currently with the St Thomas' Hospital, London.

Footnotes
Accepted for publication Feb 13, 1979.

Read before the fifth annual meeting of the New England Society for Vascular Surgery, Dixville Notch, NH, Sept 29, 1978.

Reprint requests to 3 Hawthorne Pl, Boston, MA 02114 (Dr Brewster).

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