Intraoperative embolectomy of a left illiac artery thrombus during an anterior lumbar interbody fusion

BACKGROUND: Anterior lumbar interbody fusion (ALIF) offers direct midline access to the lumbar intervertebral discs utilizing an anterior retroperitoneal approach. Here, a 33-year-old female undergoing ALIF developed an acute intraoperative left iliac artery thrombus and underwent immediate successful embolectomy. CASE DESCRIPTION: A 33-year-old female was undergoing routine L5-S1 ALIF when an acute intraoperative left iliac vein injury occurred, requiring immediate repair by a vascular surgeon. Her left foot pulse oximeter showed a decreased reading, and her Doppler ultrasound confirmed reduced flow in the distal external iliac artery due to a thrombus. She required an immediate left iliac artery embolectomy, and flow was immediately restored. Postoperatively, she recovered well, and 3 months postoperatively, she remained neurologically intact without any further complications. CONCLUSION: Using pulse oximeters in patients undergoing ALIF surgery can aid in facilitating the diagnosis and treatment of acute artery thrombi. When such vascular injuries arise, having immediate access to experienced vascular surgeons is critical to obtain expeditious treatment and optimize patient outcomes.