Abstract: Intraoperative vascular injury is infrequent complication (0.02-0.06%) during surgical operations on lumbar discs. We report a case of a 44-year-old man with oedema and varicose veins of the right lower limb. Despite an 4-year history of oedema and varicose veins, he appeared to be asymptomatic and could recollect no traumatic injury or surgery that might have caused it. Near the vertebral column, we found a small scar, the result of spinal disk surgery six years before. CT scan showed pseudoaneurysm of the right iliac artery with a 54 mm diameter. Thereafter, we located the suspected arteriovenous fistula by selective angiography of the aorta and its branches: a communication of the right iliac artery with the right iliac vein had resulted in a large shunt. This lesion was repaired by transluminal placement of stent-grafts Aorfix (Lombard Medical, UK). We had to use three stent-grafts due to the large difference in diameter between the common and external right iliac arteries. Hemodynamic improvement was immediate, and the postoperative course was uneventful. At the present time, almost six months postoperatively, the patient is asymptomatic. Sealing of pseudoaneurysm and arteriovenous fistula as a complication of lumbar-disc surgery with a stent graft is simple and is suggested as an excellent alternative to open surgery for iatrogenic vessel injuries. References 1. Canaud L., Hireche K., Joyeux F., et al. Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery. Eur. J. Vasc, Endovasc. Surg. 2011; 42 (2): 167-171. 2. Papadoulas S., Konstantinou D., Kourea H.P., et al. Vascular injury complicating lumbar disc surgery. A systematic review. Eur. J. Vasc. Endovasc. Surg. 2002; 24 (3): 189-195. 3. Mulaudzi T., Sikhosana M. Arterio-venous fistula following a lumbar disc surgery. Indian J. Orthop. 2011; 45 (6): 563-564. 4. Machado-Atias I., Fornes O., Gonzalez-Bello R., Machado-Hernandez I. Iliac arteriovenous fistula due to spinal disk surgery. Causes severe hemodynamic repercussion with pulmonary hypertension. Tex. Heart Inst. J. 1993; 20 (1): 60-64. 5. Jarstfer B., Rich N. The challenge of arteriovenous fistula formation following disk surgery: A collective review. J. Trauma. 1976; 16: 726-733. 6. Енькина Т.Н. Состояние сердечно-сосудистой системы у больных с хронической почечной недостаточностью на программном гемодиализе. Автореф. дис. ... канд. мед. Наук СПб. 1999. [En'kina T.N. Sostojanie serdechno-sosudistoj sistemy u bol'nyh s hronicheskoj pochechnoj nedostatochnost'ju na programmnom gemodialize [Condition of cardiovascular system in patients with chronic renal insufficiency on dialysis]. Avtoref. dis. ... kand. med. nauk SPb. 1999]. [In Russ]. 7. Brewster D., Cambria R., Moncure A., et al. Aortocaval and iliac arteriovenous fistulas: Recognition and treatment. J. Vasc. Surg. 1991; 13 (2): 253-264. 8. Akpinar B., Peynircioglu B., Cil B., et al. Iliac vascular complication after spinal surgery: Immediate endovascular repair following CT angiographic diagnosis. Diagn. Inters. Radiol. 2009; 15 (4): 303-305. 9. Hans S., Shepard A., Reddy P., et al. Iatrogenic arterial injuries of spine and orthopedic operations. J. Vasc. Surg. 2011; 53 (2): 407-413. 10. Zajko A., Little A., Steed D., Curtiss E. Endovascular stent-graft repair of common iliac artery-to-inferior vena cava fistula. J. Vasc, Inters. Radiol. - 1995; 6 (5): 803-806
