Endovascular Repair of 2 Iliac Pseudoaneurysms and Arteriovenous Fistula Following Spine Surgery

Purpose: To describe endovascular repair of traumatic iliac pseudoaneurysm and arteriovenous fistula (AVF) following spinal surgery. Case Report: A 48-year-old male underwent minimally invasive L5-S1 hemilaminectomy, foraminotomy, and microdiscectomy spinal surgery for trauma related to a motor-vehicle accident. Postoperative angiogram demonstrated pseudoaneurysm of the right internal iliac artery and AVF at the common iliac bifurcation with the right iliac vein with prompt filling of the iliac vein and vena cava. The second patient, a 25-year-old female, underwent minimally invasive L4-S1 hemilaminectomy, foraminotomy, and microdiscectomy spinal surgery for intractable pain and was complicated with postoperative symptoms of congestive heart failure. Postoperative angiogram demonstrated AVF between the right common iliac artery and vein with associated pseudoaneurysm formation. Endovascular repair was performed in both cases. Follow-up imaging revealed no endoleak and complete pseudoaneurysm and AVF exclusion. Conclusions: Endovascular repair of iliac injuries following spine surgery can be successfully performed with minimal morbidity.