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Iliac Vessels Injury During Disc Herniation Surgery

Knezevic Dragan

Knezevic Dragan

  • University Clinical Center Kragujevac, Center for vascular surgeryKragujevac, Serbia
  • University of Kragujevac, Faculty of Medical Sciences, Department of SurgeryKragujevac, Serbia
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Dragan, Knezevic
, 
Jokovic Vuk

Jokovic Vuk

University Clinical Center Kragujevac, Center for vascular surgeryKragujevac, Serbia
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Vuk, Jokovic
, 
Sretenovic Sasa

Sretenovic Sasa

University Clinical Center Kragujevac, Center for vascular surgeryKragujevac, Serbia
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Sasa, Sretenovic
, 
Mirkovic Nikola

Mirkovic Nikola

  • University Clinical Center Kragujevac, Center for vascular surgeryKragujevac, Serbia
  • University of Kragujevac, Faculty of Medical Sciences, Department of SurgeryKragujevac, Serbia
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Nikola, Mirkovic
, 
Prodanovic Nikola

Prodanovic Nikola

  • University Clinical Center Kragujevac, Center for vascular surgeryKragujevac, Serbia
  • University Clinical Center Kragujevac, Clinic for Orthopedic and Trauma SurgeryKragujevac, Serbia
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Nikola, Prodanovic
, 
Minic Rajko

Minic Rajko

University Clinical Center Kragujevac, Center for vascular surgeryKragujevac, Serbia
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Rajko, Minic
, 
Kovacevic Vojin

Kovacevic Vojin

  • University of Kragujevac, Faculty of Medical Sciences, Department of SurgeryKragujevac, Serbia
  • University Clinical Center Kragujevac, Center for neurosurgeryKragujevac, Serbia
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Vojin, Kovacevic
, 
Capric Marijana

Capric Marijana

University Clinical Center Kragujevac, Center for anesthesia and resuscitationKragujevac, Serbia
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Marijana, Capric
, 
Milica Vukasinovic Vesic

Milica Vukasinovic Vesic

Faculty of sports, University Union Nikola TeslaBelgrade, Serbia
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Vesic, Milica Vukasinovic
 und 
Jovanovic Dalibor

Jovanovic Dalibor

University of Kragujevac, Faculty of Medical Sciences, Department of PathologyKragujevac, Serbia
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Dalibor, Jovanovic
  
26. Juli 2025
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Artikel-Kategorie: Case Report
Online veröffentlicht: 26. Juli 2025
Eingereicht: 30. März 2024
Akzeptiert: 17. Juni 2024
DOI: https://doi.org/10.2478/eabr-2024-0050
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© 2024 Knezevic Dragan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1.

Lesion of the right common iliac artery with signs of bleeding (red arrow shows extravasation of contrast from righit common iliac artery)
Lesion of the right common iliac artery with signs of bleeding (red arrow shows extravasation of contrast from righit common iliac artery)

Figure 2.

Large retroperitonal hematoma (red arrows show a big retroperitoneal hemathoma around injured right common iliac artery)
Large retroperitonal hematoma (red arrows show a big retroperitoneal hemathoma around injured right common iliac artery)

Figure 3:

Normal findings on control MSCT angiography (red arrows show right common iliac artery and right common iliac vein on 3 years after intervention
Normal findings on control MSCT angiography (red arrows show right common iliac artery and right common iliac vein on 3 years after intervention

Figure 4.

Control MSCT angiography after three years (red arrow shows patent synthetic graft)
Control MSCT angiography after three years (red arrow shows patent synthetic graft)

Summary of Key Clinical Information on Iliac Vessel Injuries During Spinal Surgery

Aspect Details
Incidence & Severity Rare but potentially fatal, with a reported incidence of 0.04% and mortality rates between 15–60%.
Common Injuries Iliac artery and vein injuries are common, with risks of laceration, arteriovenous fistulas, and pseudoaneurysms.
Clinical Presentation Symptoms range from immediate hemorrhagic shock to asymptomatic progression. In the presented case, postoperative hemorrhagic shock occurred with a hemoglobin drop to 35g/l.
Diagnostic Approach Utilization of MSCT angiography is critical for identifying active bleeding and vascular lesions.
Surgical Intervention Emergency surgery often necessary; techniques include direct suturing and graft interposition (e.g., 8mm Dacron graft for iliac artery reconstruction in the case study).
Risk Factors Previous surgeries, close proximity of the disc to major vessels, and intraoperative challenges such as excessive instrument intrusion and inadequate positioning.
Management Strategies Vigilant peri- and postoperative monitoring is vital due to the risk of delayed massive bleeding. Both endovascular and open surgical interventions are viable depending on the scenario.
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