Iatrogenic Arteriovenous Fistula and Retroperitoneal Hemorrhage After Tapping of Lumbar Pedicle Screws: A Case Report

A 76-year-old woman underwent L4-L5 posterior lumbar interbody fusion with pedicle screws for lumbar spondylolisthesis. Intraoperative iatrogenic injuries to the right fourth lumbar artery and inferior vena cava occurred, resulting in arteriovenous fistula with extensive retroperitoneal hemorrhage. Endovascular treatment and intraperitoneal drainage were effective in managing retroperitoneal hemorrhage. She showed no sign of organ failure or deep venous thrombosis during her 2-year follow-up.

We recommend embolization both proximally and distally in the case of lumbar artery injury. Intra-abdominal hypertension secondary to a massive retroperitoneal hematoma should also be considered to prevent abdominal compartment syndrome.