Postlaminectomy Arteriovenous Fistula

Forty-nine cases of postlaminectomy arteriovenous fistula have been reported. Perforation of the anterior spinal ligament by the pituitary rongeur during discectomy with resultant simultaneous damage to artery and vein is causative. Whether aorta, cava, and/or iliac vessels are involved depends upon the level of laminectomy, the angle of the instrument, and anatomic variations in aortocaval bifurcation. Nine patients presented early after operation and were diagnosed promptly. The 40 patients who presented from months to years following laminectomy to physicians unfamiliar with this entity often had a distressing delay in diagnosis. High output congestive heart failure, particularly in a young person, and the characteristic abdominal and back bruit, should arouse suspicion. Arteriography confirms the diagnosis and allows planning for the operative repair. Though potentially disastrous, the operative correction of a major arteriovenous fistula may be done safely if standard principles of vascular surgery are followed. When combined with technical hints regarding clamp placement, transvascular repair, balloon catheter use, vein preservation, and the multiple inventive uses of the Dacron vascular prosthesis, a successful outcome should be expected.