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Unilateral leg swelling is most frequently the result of venous hypertension based on deep vein thrombosis. The suspicion of a pelvic vein thrombosis requires direct thrombus detection and exclusion of the spectrum of differential diagnoses, especially after pelvic surgery. In this paper we report a case of unilateral leg swelling with complex arteriovenous vascular pathology after minimally invasive disc surgery. The differential diagnosis and interventional therapy are discussed.