Vascular injury complicating lumbar disc surgery. A systematic review.

OBJECTIVES: to review the literature concerning the early and late vascular complications of lumbar disc surgery. METHODS: using the MEDLINE database, we reviewed all reports of vascular complications associated with surgical excision of a prolapsed disc via a posterior approach reported in the English literature since 1965. RESULTS: we identified 98 cases of vascular complications for an incidence of 1-5 in 10000 disc operations. Early presentation is shock due to rupture of a large retroperitoneal vessel. Late complications include development of pseudoaneurysms and arteriovenous fistulas. Treatment of a vascular tear consisted mainly of primary suturing of the injured vessel. The preferred method for arteriovenous fistula and pseudoaneurysm repair was suturing from within the arterial lumen along with interposition grafting. Recently, endovascular techniques have been recommended, lowering the high morbidity and mortality related to conventional repair. CONCLUSION: iatrogenic vascular injury during lumbar disc surgery, although rare, should be suspected if signs of circulatory instability are noted or if lumbar pain, leg oedema or high output cardiac failure develop months to years following such surgical procedures. However, these symptoms may arise during or immediately after surgery, requiring immediate intervention.

Popliteal venous aneurysm mimicking a soft tissue tumour. A case report.

A case of a giant, thrombosed popliteal venous aneurysm without pulmonary embolism in a 53-year-old woman is reported. Despite thorough preoperative investigation including ultrasound and magnetic resonance imaging, this was misdiagnosed as a benign soft tissue tumour. During the operation the thrombosed venous aneurysm was resected and a vein graft from the contralateral saphenous vein was interposed. Popliteal venous aneurysm is a rare entity, presenting occasionally with local signs and symptoms and more often with pulmonary embolism. The clinician should therefore keep this in mind whenever dealing with a large, soft tissue popliteal fossa mass or looking for the cause of recurrent pulmonary embolism.

Aortocaval fistula in ruptured aneurysms.

OBJECTIVES: to study incidence, clinical presentation and problems in management of aortocaval fistula in our series. DESIGN: retrospective study. MATERIALS: during a seven-year period, 112 patients operated on for abdominal aortic aneurysm, including four patients with aortocaval fistula. METHODS: standard repair of aortocaval fistula from inside the aneurysmal sac was the preferred operative technique. RESULTS: the incidence of aortocaval fistula was 3.6%. Three cases were found incidentally during emergency surgery for ruptured aneurysms; the fourth case was an isolated aortocaval fistula associated with inferior vena cava thrombosis, diagnosed preoperatively by angiography. In this case, inferior vena cava ligation instead of standard aortocaval repair was performed. CONCLUSIONS: Aortocaval fistulas, although rare, should be kept in mind, because clinical diagnosis is often difficult. Furthermore, unsuspected problems during repair may necessitate appropriate change in operative technique.

Seasonal variation of the abdominal aortic aneurysm rupture in southwestern Greece.

OBJECTIVE: To examine the hypothesis of seasonal variation in the rupture of abdominal aortic aneurysm in our region. DESIGN: Retrospective open study. SETTING: University Hospital, Greece. PATIENTS: Forty-six patients with abdominal aortic aneurysm admitted between 1991-1995. INTERVENTION: The month of admission was registered. MAIN OUTCOME MEASURES: The seasonal variation in the abdominal aortic aneurysm rupture. RESULTS: The majority of ruptures (78%) occurred during the months October and April, a phenomenon proven to be periodical (p<0.05). CONCLUSIONS: The abdominal aortic aneurysm rupture clearly showed seasonal variation.