scholarly journals Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Kentaro Kiryu ◽  
Hiroshi Yamamoto ◽  
Takayuki Kadohama ◽  
Daichi Takagi ◽  
Yoshinori Itagaki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Aortic Arch ◽  
Spinal Cord Ischemia ◽  
Lower Limbs ◽  
Arterial Calcification ◽  
Hypogastric Artery ◽  
Frozen Elephant Trunk ◽  
Peripheral Artery ◽  
Elephant Trunk ◽  
Peripheral Artery Diseases

Abstract Background Degenerative aortic arch aneurysms are known to develop through a pathological process of arterial atherosclerosis, which could be accompanied by peripheral artery diseases and resultant development of intrapelvic collateral arteries to the ischemic lower limbs. The aim of this study was to investigate the relationship between peripheral collateral circulation and postoperative paraplegia after total arch repair with a frozen elephant trunk in patients with degenerative aortic arch aneurysms and peripheral artery diseases. Methods Between October 2014 and March 2020, 27 patients (20 men; 69.8 ± 7.7 years old) underwent total arch repair with a frozen elephant trunk. Two of the 27 patients developed paraplegia postoperatively. The patients were divided into two groups, spinal cord ischemia (SCI) group (2 patients) and no-SCI group (25 patients). The aortic shagginess score, arterial calcification (subclavian artery; hypogastric artery) score, and the number of hypogastric artery branches, assessed using preoperative contrast-enhanced computed tomography images, were compared between the two groups. Results The ankle brachial artery pressure index (i.e., lower side value each patient) was lower in the SCI group than that in the no-SCI group (0.64, 0.71, and 1.09±0.07, respectively). There was no difference between the two groups in the arterial calcification scores or the aortic shagginess score. The number of hypogastric artery branches was greater in the SCI group than in the no-SCI group (66, 66, and 30.7±7.5, respectively). Conclusions Enhanced collateral circulation to the ischemic lower limbs in patients with combination of degenerative aortic arch aneurysms and peripheral artery diseases may be involved in paraplegia the upper thoracic spinal cord injury after total arch repair with a frozen elephant trunk.

Spinal Cord Ischemia Rescue after Hybrid Total Arch Repair with Frozen Elephant Trunk: A Case Report

2020 ◽  
Vol 66 ◽  
pp. 669.e5-669.e9
Author(s):  
Alexander D. Leung ◽  
Peter B. Bartline ◽  
Charles W. Acher ◽  
Dai Yamanouchi
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Spinal Cord Ischemia ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk

Spinal Cord Ischemia After Selective Cerebral Perfusion in a Porcine “Frozen Elephant Trunk” Simulation Model

2015 ◽  
Vol 99 (5) ◽  
pp. 1624-1631 ◽  
Author(s):  
Peter L. Haldenwang ◽  
Nora Prochnow ◽  
Andreas Baumann ◽  
Dirk Buchwald ◽  
Lorine Häuser ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Simulation Model ◽  
Cerebral Perfusion ◽  
Spinal Cord Ischemia ◽  
Frozen Elephant Trunk ◽  
Selective Cerebral Perfusion ◽  
Elephant Trunk

Total Aortic Arch Replacement and Frozen Elephant Trunk

2020 ◽  
Author(s):  
Jacky Y.K. Ho ◽  
Simon C.Y. Chow ◽  
Micky W.T. Kwok ◽  
Takuya Fujikawa ◽  
Randolph H.L. Wong
Keyword(s):  
Aortic Arch ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Total Aortic Arch Replacement

Hypogastric Artery Stenting for Chronic Intermittent Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 27 (5) ◽  
pp. 801-804
Author(s):  
Catharina Gronert ◽  
Nikolaos Tsilimparis ◽  
Giuseppe Panuccio ◽  
Ahmed Eleshra ◽  
Fiona Rohlffs ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Neurological Symptoms ◽  
Endovascular Aortic Repair ◽  
Hypogastric Artery ◽  
Lower Extremity Weakness ◽  
Aortic Repair ◽  
The Right

Purpose: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting. Case Report: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA. Conclusion: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.

scholarly journals Acute-onset paraplegia as an unexpected complication under general anesthesia in supine position during abdominal endovascular aneurysm repair: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Atsushi Morio ◽  
Hirotsugu Miyoshi ◽  
Noboru Saeki ◽  
Yukari Toyota ◽  
Yasuo M. Tsutsumi
Keyword(s):  
Spinal Cord ◽  
General Anesthesia ◽  
Supine Position ◽  
Spinal Cord Ischemia ◽  
Endovascular Aneurysm Repair ◽  
Acute Onset ◽  
Lower Limbs ◽  
Canal Stenosis ◽  
Cord Injury ◽  
Aneurysm Repair

Abstract Background Acute onset paraplegia after endovascular aneurysm repair (EVAR) is a rare but well-known complication. We here show a 79-year-old woman with paraplegia caused by static and dynamic spinal cord insult not by ischemia after EVAR. Case presentation The patient underwent EVAR for abdominal aortic aneurism under general anesthesia in the supine position. She had a medical history of lumbar canal stenosis. After the surgery, we recognized severe paraplegia and sensory disorder of lower limbs. Although the possibility of spinal cord ischemia was considered at that time, postoperative magnetic resonance imaging (MRI) revealed burst fracture of vertebra and compressed spinal cord. Conclusions Patients with spinal canal stenosis can cause extrinsic spinal cord injury even with weak external forces. Thus, even after EVAR, it is important to consider extrinsic factors as the cause of paraplegia.

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