[Vascular complications during surgery of lumbar disk herniation. Apropos of 3 personal cases and 37 cases from a national investigation].

Three personal cases of iatrogenic vascular complications (two arterial wounds and one arteriovenous fistula) induced by lumbar herniation surgery led to a French national investigation among vascular and neurosurgical units where 37 other such cases have been discovered over 10 years (1984-1994). In 23 cases, the initial symptomatology was collapses by arterial (22 cases) or venous (one case) hemorrhage requiring emergency vascular repair surgery; in 17 cases an arterio-venous fistula was found in a period varying from a few hours to 5 years after surgery; it was revealed by cardiac failure, lower limb edema or abdominal thrill. Among the 40 cases, 77% occurred at the L4-L5 level; the mortality was 5%, and the morbidity was 27%. Origin, causes and prevention are discussed.