Abstract
Postoperative paraplegia secondary to spinal cord ischemia (SCI) is an extremely rare and devastating complication of endovascular repair in abdominal aortic aneurysm (AAA) surgery. The reported incidence is only 0.21 % worldwide. This case of postoperative paraplegia occurred in a 60-year-old man immediately following endovascular repair of an infrarenal AAA. Postoperative magnetic resonance imaging showed multiple foci of SCI involvement from C5 to L1. However, neither cerebral spinal fluid drainage nor steroid therapy was effective; he was eventually admitted with no improvement in his neurological status. The mechanism remains multifactorial until now and needs more attention in perioperative management. We report the first case involved in the most significantly extensive SCI after endovascular repair of an infrarenal AAA.
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Gravereaux EC, Faries PL, Burks JA. Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms. J Vasc Surg. 2001;34:997–1003.
Greenhalgh RM. United Kingdom EVAR trial investigators: endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1863–71.
Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, Buskens E, Grobbee DE, Blankensteijn JD. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607–18.
Drury D, Michaels JA, Jones L, Ayiku L. Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm. Br J Surg. 2005;92(8):937–46.
Garcia ND, Tehrani H, Morasch M, Pearce W, Matsumura J. Spinal cord ischemia following endovascular repair of an infrarenal aortic aneurysm. Ann Vasc Surg. 2002;16:509–12.
Rockman CB, Riles TS, Landis R. Lower extremity paraparesis or paraplegia subsequent to endovascular management of abdominal aortic aneurysms. J Vasc Surg. 2001;33:178–80.
Reid JA, Mole DJ, Johnston LC, Lee B. Delayed paraplegia after endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 2003;37(6):1322–3.
Berg P, Kaufmann D, van Marrewijk CJ, Buth J. Spinal cord ischemia after stent graft treatment for infra-renal abdominal aortic aneurysms. Analysis of the Eurostar database. Eur J Vasc Endovasc Surg. 2001;22(4):342–7.
Bhama JK, Lin PH, Voloyiannis T, Bush RL, Lumsden AB. Delayed neurologic deficit after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2003;37:690–2.
Rosenthal D. Spinal cord ischemia after abdominal aortic operation: is it preventable? J Vasc Surg. 1999;30:391–7.
Minatoya K, Karck M, Hagl C, Meyer A, Brassel F, Harringer W, Haverich A. The impact of spinal angiography on the neurological outcome after surgery on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg. 2002;74(5):1870–2 (discussion S1892–S1898).
Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol. 2006;63(8):1113–20.
McGarvey ML, Mullen MT, Woo EY, Bavaria JE, Augoustides YG, Messé SR, Cheung AT. The treatment of spinal cord ischemia following thoracic endovascular aortic repair. Neurocrit Care. 2007;6(1):35–9.
Chiesa R, Melissano G, Marrocco-Trischitta MM, Civilini E, Setacci F. Spinal cord ischemia after elective stent-graft repair of the thoracic aorta. J Vasc Surg. 2005;42(1):11–7.
Riess KP, Gundersen SB 3rd, Ziegelbein KJ. Delayed neurologic deficit after infrarenal endovascular aortic aneurysm repair. Am Surg. 2007;73(4):385–7.
Dong CC, MacDonald DB, Janusz MT. Intra-operative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery. Ann Thorac Surg. 2002;74:S1873–6.
Jacobs MJ, Mess W, Mochtar B, Nijenhuis RJ, Statius van Eps RG, Schurink GW. The value of motor evoked potentials in reducing paraplegia during thoracoabdominal aneurysm repair. J Vasc Surg. 2006;43:239–46.
Cheung AT, Pochettino A, McGarvey ML, Appoo JJ, Fairman RM, Carpenter JP, Moser WG, Woo EY, Bavaria JE. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysm. Ann Thorac Surg. 2005;80(4):1280–8.
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Ke, CC., Feng, YP., Chang, CC. et al. Extensive spinal cord ischemia following endovascular repair of an infrarenal abdominal aortic aneurysm: a rare complication. J Anesth 27, 956–959 (2013). https://doi.org/10.1007/s00540-013-1635-3
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DOI: https://doi.org/10.1007/s00540-013-1635-3