The iliolumbar vein drains into the common iliac vein and receives tributaries from the iliacus, psoas, and lumbar muscles. Its tributaries run alongside the iliolumbar artery branches and form the venous drainage of the iliolumbar territory.
The iliolumbar vein tributaries are the source of haemorrhage during lumbosacral anterior approach when the vein is not identified before L5-S1 disc access. Venous bleeding in the deep retroperitoneal iliolumbar territory is difficult to control due to vessel retraction. Preoperative CTA identifies the iliolumbar vein anatomy before anterior lumbar surgery.
Bleeding from iliolumbar vein tributaries during L5-S1 anterior disc access producing rapid retroperitoneal haemorrhage, prevented by lateral-to-medial dissection with prior iliolumbar vein identification and ligation.
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