Delayed neurologic deficit after endovascular abdominal aortic aneurysm repair

Abstract

Paraplegia or paraparesis secondary to spinal cord ischemia is an extremely rare complication after elective repair of abdominal aortic aneurysm. We report delayed paraparesis after endovascular abdominal aortic aneurysm repair in which one hypogastric artery was unintentionally occluded due to atheroembolism. A spinal catheter was immediately inserted after onset of paraplegia to promote cerebrospinal fluid drainage, which partially reversed the neurologic deficit. Our case underscores both the importance of the critical spinal collateral supply from the hypogastric artery and the role of spinal fluid drainage to maximize spinal cord perfusion in the setting of spinal cord ischemia.

Paraplegia following the emergency surgical repair of a nonruptured symptomatic abdominal aortic aneurysm: Report of a case

“…In previous studies, some patients recovered from spinal cord dysfunction following CSF drainage; these patients usually had incomplete neurological damage, with no spinal cord infarction detected on magnetic resonance imaging. 3,8,13,15 However, complete paralysis with obvious spinal cord infarction, similar to that observed in our case, is considered irreversible.…”

“…The proposed treatment measures for this condition include CSF drainage, systemic steroid administration, permissive hypertension, and intensive physical therapy. 13,14 Cerebrospinal fl uid drainage is the most effective of these measures for reversing this neurological condition, which is considered to arise due to an increased blood fl ow in the spinal cord following a CSF-pressure decrease. In previous studies, some patients recovered from spinal cord dysfunction following CSF drainage; these patients usually had incomplete neurological damage, with no spinal cord infarction detected on magnetic resonance imaging.…”

Delayed permanent paraplegia after endovascular repair of abdominal aortic aneurysm

“…6,11 Additional factors implicated in SCI after EVAR include intentional or inadvertent coverage of one or both hypogastric arteries, and atheroembolization due to wire manipulation. 5,12,13 This patient had two significant anatomic compromises to the spinal cord circulation: the endograft was situated more proximally than is customary (originating at the level of the SMA potentially covering more lumbar arteries), and one hypogastric artery was electively embolized at its origin. There were no prominent lumbar arteries or a patent IMA noted on initial angiography before endograft deployment (Fig 4).…”

Cord and Cauda Equina Injury Complicating Elective Orthopedic Surgery

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] It occurs most commonly as a complication of repair of a thoracic or infrarenal aortic aneurysm, as a result of spinal cord ischemia. 2,4 -8,10 -12 Spinal cord ischemia has also been reported following endovascular repair of aortic aneurysms.…”

“…2,4 -8,10 -12 Spinal cord ischemia has also been reported following endovascular repair of aortic aneurysms. 2,6,8,11,12 The perioperative risk for spinal cord ischemia from surgical repair of thoracoabdominal aneurysms has been estimated to occur at a rate of 5% to 21% 8 and may result in significant patient morbidity. 14 Cord and cauda equina injury has also been reported after emergent laparotomy in polytraumatized patients, as a result of positioning changes in the face of an unstable spine.…”