Six months after lumbar disc surgery, a 43-year-old woman presented with signs and symptoms of high-output circulatory failure secondary to an acquired abdominal arteriovenous fistula. Unusual findings in this case included a continuous murmur, which was transmitted to the soles of both feet and pericardial effusion, both of which disappeared after corrective surgery. Echocardiography demonstrated resolution of chamber enlargement following repair of the fistula. The mechanism of vascular injury during disc surgery and hemodynamic effects of such A-V fistulas are discussed.
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