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[Arteriovenous fistula following surgery of intervertebral disk]
Insights
Vascular damage during spinal surgery can cause arteriovenous fistulas, a rare complication. This case highlights a late presentation mimicking heart failure, emphasizing the need for surgical repair for recovery.
Area of Science:
- Vascular Surgery
- Intervertebral Disc Surgery
- Cardiology
Background:
- Vascular damage during intervertebral disc surgery is a rare but serious complication.
- Arteriovenous fistulas (AVFs) can form secondary to such surgical trauma.
- Approximately one hundred cases of spinal surgery-induced AVFs have been documented.
Observation:
- This report details a unique case of AVF presenting late, initially misdiagnosed as primary congestive cardiac failure.
- Preoperative instrumental maneuvers were crucial in elucidating the underlying arteriovenous fistula mechanisms.
- The typical early diagnosis of AVF, characterized by venous hypertension, was absent in this instance.
Findings:
- Late presentation of arteriovenous fistula following intervertebral disc surgery is possible.
- Congestive cardiac failure can be an atypical manifestation of spinal AVF.
- Preoperative diagnostic techniques can reveal the pathophysiology of complex vascular lesions.
Implications:
- Surgical correction is the definitive treatment for spinal arteriovenous fistulas.
- Arterial and venous repair, often with prosthetic materials, is necessary for successful outcomes.
- While surgical repair offers significant recovery, the overall mortality associated with this pathology remains a consideration.
Abstract:
Vascular damage during intervertebral disc surgery is uncommon. It sometimes leads to the formation of an arteriovenous fistula and about one hundred cases have been reported in the literature. The diagnosis is often early, with signs of venous hypertension predominating. The authors report a case of arteriovenous fistula presenting late as apparently primary congestive cardiac failure. The mechanisms of this condition were demonstrated during preoperative instrumental manoeuvres. Surgical correction is the only treatment alternative. Repair must be arterial and venous, most often using prosthetic material. This generally enables total and permanent recovery, but overall mortality in pathology of this type is not nil.