Iliac Vessels Injury During Disc Herniation Surgery

Iliac vessel injuries during spinal surgery are rare but can be fatal. The incidence of these injuries is approximately 0.04%, with the first description dating back to 1945 by Linton and White. Clinical presentation can range from acute hemorrhagic shock to subtle injuries with asymptomatic progression. We present the case of a 53-year-old previously healthy female undergoing planned surgical treatment for a disc hernia at the L4-L5 level on the left. Postoperatively, she experienced hemorrhagic shock with a decrease in hemoglobin to 35g/l. An emergency MSCT angiography verified a vascular lesion. During urgent surgical intervention, a lesion of the common iliac vein was observed, which was sutured directly, and a lesion of the right common iliac artery, which was managed by interposition of an 8mm Dacron graft. Follow-up MSCT angiography showed normal findings. During spinal surgery, it is essential to be aware of the possibility of vascular lesions. Due to the potential occurrence of delayed massive bleeding, intensive peri- and postoperative monitoring of patients after spinal surgery is necessary.