Successful Treatment of Delayed Onset Paraplegia after Suprarenal Abdominal Aortic Aneurysm Repair

Weiss, Stuart J.; Hogan, Michael S; McGarvey, Michael L.; Carpenter, Jeffrey P.; Cheung, Albert T.

doi:10.1097/00000542-200208000-00031

Cited by 11 publications

(6 citation statements)

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“…The greater risk of spinal cord ischemia in patients with prior abdominal aortic aneurysm repair may be explained by possible compromise of pelvic and hypogastric collateral that supply the anterior spinal artery [20,21] Many patients in group A in whom Adamkiewicz artery was detected by MRA did not have spinal cord ischemia after endovascular stent-graft repair even if the intercostal artery to ARM was occluded by inserting the stent-graft. There has been a great difference of opinion regarding the importance of reimplanting the intercostal artery to ARM in open repair.…”

Section: Discussionmentioning

confidence: 99%

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Kawaharada

Morishita

Kurimoto

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Background: We reviewed our experience to investigate the determinants of paraplegia/paraparesis after endovascular stent-graft repair of the thoracic aorta, to assess the influence of the artery of Adamkiewicz (ARM) detected by preoperative magnetic resonance angiography (MRA) and to identify patients at risk. Methods: Over a 5-year period (March 2001-June 2006, 149 patients underwent elective endovascular stentgraft repair of the descending thoracic aorta. Patient demographics and perioperative factors relating to the endovascular procedure were evaluated by using univariate statistical analyses. To assess the influence of the ARM in the thoracolumbar region, patients in whom ARM was detected by preoperative MRA were divided into two groups: patients who had occlusion of the intercostal artery for ARM due to stent-graft (group A, n = 33) and patients who had patency of the intercostal artery for ARM following stent-graft (group B, n = 38). Results: Five (3.6%) of the 144 patients had paraparesis/paraplegia. Two of these five patients had previously undergone operation for total arch replacement with elephant trunk and one had surgery for descending aortic repair. Univariate analyses identified only prior aortic surgery as a significant risk factor ( p = 0.04). Paraparesis/paraplegia rates were 10% (three patients) in group A and 0% in group B ( p = 0.09). Conclusion: Prior thoracic aortic replacement was found to be a significant predictor of spinal cord ischemia, and therefore vigilance is needed regarding occlusion of the intercostal artery for ARM detected prior to stent-graft repair. #

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Section: Discussionmentioning

confidence: 99%

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Kawaharada

Morishita

Kurimoto

et al. 2007

European Journal of Cardio-Thoracic Surgery

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“…In open thoracoabdominal aortic repair, blood pressure augmentation has been shown to play a role in reversing SCI, 38 which it to be expected based on the physiological principle that spinal cord perfusion pressure is the difference between MAP and CSF pressure. Cheung et al 33 and Weiss et al 39 have shown similar results in endovascular abdominal as well as thoracic repair. This result is especially useful in patients presenting with delayed onset paraparesis or paraplegia.…”

Section: Intensive Care Unit Management Of Tevarmentioning

confidence: 73%

Intensive Care Management of Thoracic Aortic Surgical Patients, Including Thoracic and Infradiaphragmatic Endovascular Repair (EVAR/TEVAR)

Cole

2015

Semin Cardiothorac Vasc Anesth

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The patient with thoracic aortic disease can present for open or endovascular repair. Thoracic endovascular aortic repair (TEVAR) has emerged as a minimally invasive option for a multitude of aortic pathology, including dissections, aneurysms, traumatic injuries, and ulcers. Postoperative management of these patients depends on the extent of procedure, whether it was open or endovascular, and, finally, on the preoperative comorbidities present. While procedural success has catapulted TEVAR to popularity, midterm results have been mixed. Additionally, periprocedural complications such as paraplegia and renal failure remain a significant morbidity in these patients.

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“…The length of the deployed stent-graft was expected to be at least 8 zone numbers. The length of the stent-graft is one of the risk factors for SCI and prior abdominal aortic aneurysm repair may produce a greater risk of SCI by a possible compromise of the pelvic and hypogastric collateral that supply the anterior spinal artery [12,13]. …”

Section: Discussionmentioning

confidence: 99%

Two-Stage Endovascular Repair for Concurrent Penetrating Atherosclerotic Ulcers of the Thoracic and Abdominal Aorta

Kong

Baek

Kwun

et al. 2013

Korean J Thorac Cardiovasc Surg

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We report a case of concurrent saccular aneurysms caused by a penetrating atherosclerotic ulcer of the thoracic and abdominal aorta that were successfully treated by staged endovascular repair. Even though surgical open repair or endovascular repair is the treatment option, use of endovascular repair is now accepted as an alternative treatment to surgery in selected patients. To prevent contrast medium-induced nephropathy and spinal cord ischemia caused by a simultaneous endovascular procedure, a saccular aneurysm of the descending thoracic aorta was excluded by stent graft, followed by the placement of a bifurcated stent graft in the infrarenal abdominal aorta one month later.

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Successful Treatment of Delayed Onset Paraplegia after Suprarenal Abdominal Aortic Aneurysm Repair

Cited by 11 publications

References 0 publications

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Intensive Care Management of Thoracic Aortic Surgical Patients, Including Thoracic and Infradiaphragmatic Endovascular Repair (EVAR/TEVAR)

Two-Stage Endovascular Repair for Concurrent Penetrating Atherosclerotic Ulcers of the Thoracic and Abdominal Aorta

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