Thoracic Endovascular Repair of Spinal Cord Infarction Resulting from Impending Rupture of the Thoracic Aortic Aneurysm

Purpose: To report a dramatic complication after endovascular repair of a descending thoracic aortic aneurysm (TAA) and to present a classification system and possible methods to avoid spinal cord ischemia. Case Report: A 48-year-old man with a descending TAA between T5 and T9 was treated with endovascular stent-grafts. Fourteen hours after the operation, the patient developed partial transverse myelopathy at level T10. During emergency conversion to open surgery and implantation of a conventional tube graft, 3 intercostal arteries that had been covered by the stent-graft were revascularized. Postoperatively, the neurological deficit improved, and the patient was able to walk again. Methods to predict and possibly prevent the induction of spinal cord ischemia after endovascular repair of TAA are suggested. Conclusions: Endovascular repair of TAA may induce spinal cord ischemia; pre- and intraoperative assessment of involved intercostal arteries should be performed.

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Two Cases of Thoracic Aortic Aneurysm with Right Aortic Arch: Comparison of Two Operative Strategies for Hybrid Thoracic Endovascular Repair

Annals of Vascular Diseases ◽

10.3400/avd.cr.14-00038 ◽

2014 ◽

Vol 7 (3) ◽

pp. 343-346 ◽

Cited By ~ 1

Author(s):

Takeshi Onohara ◽

Yoshinobu Nakamura ◽

Yuichiro Kishimoto ◽

Shingo Harada ◽

Yoshikazu Fujiwara ◽

...

Keyword(s):

Aortic Aneurysm ◽

Aortic Arch ◽

Endovascular Repair ◽

Thoracic Aortic Aneurysm ◽

Right Aortic Arch ◽

Thoracic Endovascular Repair ◽

Operative Strategies

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Low-density vulnerable thrombus/plaque volume on preoperative CT predicts spinal cord ischemia after endovascular repair for thoracic aortic aneurysm.

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.09.026 ◽

2020 ◽

Author(s):

Hiroshi Banno ◽

Yohei Kawai ◽

Tomohiro Sato ◽

Takuya Tsuruoka ◽

Masayuki Sugimoto ◽

...

Keyword(s):

Spinal Cord ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Thoracic Aortic Aneurysm ◽

Spinal Cord Ischemia ◽

Low Density ◽

Plaque Volume ◽

Preoperative Ct

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Abstract TP157: Rates of Spinal Cord Infarction After Repair of Aortic Aneurysm or Dissection

Stroke ◽

10.1161/str.48.suppl_1.tp157 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Gino Gialdini ◽

Alexander E Merkler ◽

Neal S Parikh ◽

Michael P Lerario ◽

Abhinaba Chatterjee ◽

...

Keyword(s):

Spinal Cord ◽

New York ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Surgical Repair ◽

Secondary Analysis ◽

Unruptured Aneurysm ◽

Ruptured Aneurysm ◽

Spinal Cord Infarction ◽

Aortic Repair

Introduction: The rate of spinal cord infarction associated with repair of an aortic aneurysm or dissection is uncertain. Methods: We identified all adult patients discharged from nonfederal acute care hospitals in California, New York, and Florida who underwent surgical or endovascular repair of a thoracic or abdominal aortic aneurysm or dissection between 2005 and 2013. Our outcome was a spinal cord infarction ( ICD9-CM codes: 336.1 or 344.1-5) occurring during the index hospitalization for aortic repair. Patients with a spinal cord infarction prior to the hospitalization for aortic repair were excluded. Descriptive statistics with exact confidence intervals (CIs) were used to report crude rates of spinal cord infarction in patients with repair of ruptured aortic aneurysm or dissection and in patients with repair of unruptured aneurysm. In a secondary analysis, we evaluated the rate of spinal cord infarction in these groups by treatment approach – surgical versus endovascular. Results: We identified 116,892 patients who underwent repair for an aortic aneurysm or dissection, and spinal cord infarction was diagnosed in 658 cases (0.56%, 95% CI, 0.52-0.61%). Patients with spinal cord infarction were more often male and more likely to have vascular risk factors. In patients undergoing repair of a ruptured aneurysm or dissection, the rate of spinal cord infarction was 1.91% (95% CI, 1.70-2.13%), compared to 0.35% (95% CI, 0.32-0.39%) in patients undergoing repair of an unruptured aneurysm. In secondary analysis of patients with repair of ruptured aneurysm or dissection, spinal cord infarction occurred in 1.88% (95% CI, 1.63-2.13%) of those undergoing surgical repair and 2.01% (95% CI, 1.59-2.44%) of those undergoing endovascular repair. For patients with repair of unruptured aneurysm, spinal cord infarction occurred in 0.42% (95% CI, 0.36-0.47%) of those undergoing surgical repair and 0.29% (95% CI, 0.24-0.33%) of those undergoing endovascular repair. Conclusions: Clinically apparent spinal cord infarction results from approximately 1 in 50 procedures to repair an aortic dissection or ruptured aneurysm and 1 in 300 procedures to repair an unruptured aortic aneurysm.

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Aneurysm of the descending thoracic aorta presenting with paraplegia which significantly resolved following surgical repair

International Surgery Journal ◽

10.18203/2349-2902.isj20210024 ◽

2021 ◽

Author(s):

Firas Aljanadi ◽

Joseph Doyle

Keyword(s):

Spinal Cord ◽

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Surgical Repair ◽

Sudden Onset ◽

Spinal Cord Infarction ◽

Intraluminal Thrombus ◽

Neurological Improvement ◽

Descending Aortic Aneurysm ◽

Spinal Mri

Spinal cord infarction secondary to dissecting thoracic aortic aneurysm is a relatively rare phenomenon; it is uncommon for descending aortic aneurysm to present with paraplegia. We report the case of 60 year old man presenting with sudden onset paraplegia secondary to spinal cord infarction caused by dissecting thoracic aortic aneurysm with intraluminal thrombus. Spinal MRI confirmed findings and he underwent emergency surgery. Post-operatively he displayed neurological improvement, and was mobilising with a frame by 2-month outpatient clinic review.

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