Paraplegia following saddle embolism

Dickson, Alan P.; Lum, S K; Whyte, A S

doi:10.1002/bjs.1800710429

Cited by 11 publications

(5 citation statements)

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“…And more proximal location of clot causes a severe ischemia due to the lower possibility of compensation by the collateral circulation. Acute aorto-iliac occlusion could lead to limb ischemia, tissue necrosis, even amputation and /or death due to severe reperfusion injury and rapid multiple organ failure ( 2 , 3 , 14 ). A rapid diagnosis and management are important ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Mechanical Thrombectomy for Acute Limb Ischemia With Aorto-iliac Occlusion

Yang

Yin

et al. 2022

Front. Surg.

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BackgroundTo evaluate the outcomes of percutaneous mechanical thrombectomy (PMT) with Rotarex catheter in patients with acute lower limb ischemia (ALI) caused by aorto-iliac occlusion.Materials and MethodsData of patients with ALI caused by aorto-iliac occlusion in our institutions from January 2010 and April 2020 were reviewed. The primary end point was limb salvage rate. The secondary end points included technical success rate, survival rate, complications after the operation and during the follow-up.ResultsA total of 85 patients with ALI was diagnosed with aorto-iliac occlusion. Thirty-eight patients were treated by PMT with Rotarex catheter and enrolled in present study. Twenty-four were male (63.2%), and 14 were female (36.8%). The mean age was 66 years (range 28–83). All 38 patients were treated with PMT, with additional catheter directed thrombolysis (2/38, 5.3%), balloon angioplasty (8/38, 21.1%) and stent deployment (7/38, 18.4%). The mean procedure time was 123 ± 31 min. Seven patients (18.4%) underwent continuous renal replacement therapy. Two patients received major amputations (above the knee) and 2 patients died for renal insufficiency and heart failure during the hospital stay. Thirty-day survival rate was 94.7% and limb salvage was 94.4%. The mean follow-up time was 14.0 months (8–22 months). There was no major amputation and target artery occlusion occurred during the follow-up period.ConclusionPMT with Rotarex catheter could be new option for acute aorto-iliac occlusion, leading to safe and effective results.

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Section: Discussionmentioning

confidence: 99%

“…Acute aorto-iliac occlusion is an emergency critical disease with high risk of amputation and life-threatening complications ( 1 – 3 ). Previous studies reported on a substantial amount of mortality was as high as 75% ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Mechanical Thrombectomy for Acute Limb Ischemia With Aorto-iliac Occlusion

Yang

Yin

et al. 2022

Front. Surg.

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“…To fully appreciate the rarity of this complication of an embolic cause of AAO first reported nearly 35 years ago [16], one must understand the vascular supply to the distal spinal cord. The principle arterial supply to this region of the spinal cord is through the intrinsic vasculature provided via the greater radicular artery (GRA), also known as the Artery of Adamkiewicz.…”

Section: Discussionmentioning

confidence: 99%

“…In the remaining patients a low point of origin of the GRA may occur at the level of L3 (1.4%) or L4-L5 (0.2%) with the balance of the vascular supply provided by the anastomotic arterial ansa of the conus at L1–L5 supplied by the pelvic vasculature [18]. It is therefore unlikely that a distal aortic saddle embolism would result in spinal cord ischemia unless the obstruction is exceedingly long and completely occlusive or if the origin of the GRA is abnormally low [16]. Given that our patient had complete vascular obstruction to the level of the third lumbar vertebra accompanied with the rapid onset of a dense paraplegia it is highly likely that our patient has an abnormally low origin to the GRA.…”

Section: Discussionmentioning

confidence: 99%

Acute Paraplegia as a Presentation of Aortic Saddle Embolism

Irizarry

Wray

Guishard

2016

Case Reports in Emergency Medicine

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Background. Acute onset paraplegia has a myriad of causes most often of a nonvascular origin. Vascular etiologies are infrequent causes and most often associated with postsurgical complications. Objective. To describe the occurrence and possible mechanism for aortic saddle embolism as a rare cause of acute paraplegia. Case Report. Described is a case of a 46-year-old female who presented with the sudden onset of nontraumatic low back pain with rapidly progressive paraplegia which was subsequently determined to be of vascular origin.

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“…Literature is scarce regarding the incidence and recovery from paraplegia complicating a saddle em bolus. [5][6][7] Case report A 47 year old man was admitted to hospital on 11th October 1992 at 11 am with a history of sudden onset an hour previously of severe pain in the lower back and both lower limbs with inability to move both lower limbs and numb ness. He was a known diabetic (NIDDM) on oral hypoglycaemic agents with 'good' control.…”

Section: Introductionmentioning

confidence: 99%

Recovery from paraplegia following aortic saddle embolism. Case report

Chandrashekar¹,

Acharya²,

Rao

et al. 1994

Spinal Cord

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An aortic saddle embolus causing paraplegia is rare and even rarer is a documentation of neurological recovery from this event. A 47 year old male presented with absent pulsations in the lower limbs and paraplegia, both of sudden onset. He underwent immediate bilateral transfemoral embolectomy.The postoperative period was stormy. The paraplegia recovered over a period of 2 months and he could walk to his place of work after 6 months. The rare combination of saddle embolus and paraplegia is discussed. An attempt has been made to verify the hypothesis of Dickson et al which states that a low origin of the great radicular artery (GRA) below TI2 level may be responsible for paraplegia when obstructed by a saddle embolus. We found the GRA arising at L2 vertebral level in this patient. Postoperative selective spinal arteriogram and magnetic resonance imaging (MRI) of the spinal cord showed a patent GRA and normal spinal cord structure respectively. Early surgical intervention in restoring the blood flow into the GRA may prevent severe histological changes hitherto responsible for nonrecovery from paraplegia in the earlier reports.

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Paraplegia following saddle embolism

Cited by 11 publications

References 1 publication

Percutaneous Mechanical Thrombectomy for Acute Limb Ischemia With Aorto-iliac Occlusion

Percutaneous Mechanical Thrombectomy for Acute Limb Ischemia With Aorto-iliac Occlusion

Acute Paraplegia as a Presentation of Aortic Saddle Embolism

Recovery from paraplegia following aortic saddle embolism. Case report

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