We report a case of thrombotic occlusion of left external iliac artery during the procedure of anterior lumbar interbody fusion. The diagnosis was confirmed by computed tomography angiography. The patient also developed severe rhabdomyolysis postoperatively. In spite of receiving emergent thromboendarterectomy, the patient expired on postoperative day 3. This report attempts to remind spinal surgeons and anesthesiologists of this rare but potentially fatal complication, and discuss the possible mechanism, management, and prevention.