Spinal Cord Infarction Caused by Non-dissected and Unruptured Thoracoabdominal Aortic Aneurysm with Intraluminal Thrombus

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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Faculty Opinions recommendation of Motor and somatosensory evoked potentials: their role in predicting spinal cord ischemia in patients undergoing thoracoabdominal aortic aneurysm repair with regional lumbar epidural cooling.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1138081.595198 ◽

2008 ◽

Author(s):

J Richard Toleikis

Keyword(s):

Spinal Cord ◽

Aortic Aneurysm ◽

Evoked Potentials ◽

Somatosensory Evoked Potentials ◽

Spinal Cord Ischemia ◽

Thoracoabdominal Aortic Aneurysm ◽

Thoracoabdominal Aortic Aneurysm Repair ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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Re: ‘Editor's Choice – The Impact of Early Pelvic and Lower Limb Reperfusion and Attentive Peri-operative Management on the Incidence of Spinal Cord Ischemia During Thoracoabdominal Aortic Aneurysm Endovascular Repair’

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2015.10.023 ◽

2016 ◽

Vol 51 (2) ◽

pp. 315-316

Author(s):

M.S. Farooq

Keyword(s):

Spinal Cord ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Lower Limb ◽

Spinal Cord Ischemia ◽

Thoracoabdominal Aortic Aneurysm ◽

Operative Management ◽

The Impact

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Surgical Thoracoabdominal Aortic Aneurysm Repair in a Non-High-Volume Institution

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1708470 ◽

2020 ◽

Author(s):

Takashi Kunihara ◽

Claudia Vukic ◽

Fumihiro Sata ◽

Hans-Jaochim Schäfers

Keyword(s):

Spinal Cord ◽

Logistic Regression ◽

Aortic Aneurysm ◽

Regression Model ◽

Logistic Regression Model ◽

Thoracoabdominal Aortic Aneurysm ◽

Left Ventricular ◽

Multivariable Logistic Regression Model ◽

Multivariable Logistic Regression ◽

Cord Injury

Abstract Background Surgical thoracoabdominal aortic aneurysm (TAAA) repair remains challenging. Apart from mortality, spinal cord injury (SCI) is a dreaded complication. We analyzed our experience to identify predictors for SCI in a nonhigh-volume institution. Patients and Methods All patients who underwent TAAA repair between February 1996 and November 2016 (n = 182) were enrolled. Most were male (n = 121; 66.4%), median age was 68 years (range: 21–84). Elective operations were performed in 153 instances (84.1%). Our approach to minimize SCI includes distal aortic perfusion, mild hypothermia, identification of the Adamkiewicz artery, and sequential aortic clamping. Cerebrospinal fluid drainage was introduced in 2001 and liberal use of selective visceral perfusion in 2006. Results Early mortality was 12.1%; it was 8.5% after elective procedures. Reduced left ventricular function, nonelective setting, older age, and longer bypass time were identified as independent predictors for mortality in multivariable logistic regression model. Permanent SCI was observed in nine patients (4.9%), of whom seven (3.8%) developed paraplegia. In a multivariable logistic regression model for paraplegia, peripheral arterial disease (PAD), Crawford type II repair, smaller body surface area, and era before 2001 were identified as independent predictors, whereas only PAD was significant for SCI. The incidence of paraplegia was 13.8% in extensive repair out of the first 91 cases, whereas it was improved up to 2.7% thereafter. Conclusion Using an integrated approach, acceptable outcome of TAAA repair can be achieved, even in a nonhigh-volume center. PAD and extensive involvement of the aorta are strong independent predictors for spinal cord deficit after TAAA repair.

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Changes in Cerebrospinal Fluid Pressure and Lactate Concentrations during Thoracoabdominal Aortic Aneurysm Surgery

Anesthesiology ◽

10.1097/00000542-199701000-00007 ◽

1997 ◽

Vol 86 (1) ◽

pp. 41-47 ◽

Cited By ~ 42

Author(s):

Benjamin Drenger ◽

Stephen D. Parker ◽

Steven M. Frank ◽

Charles Beattie

Keyword(s):

Spinal Cord ◽

Cerebrospinal Fluid ◽

Aortic Aneurysm ◽

Aortic Surgery ◽

Thoracoabdominal Aortic Aneurysm ◽

Aortic Occlusion ◽

Aneurysm Surgery ◽

Csf Pressure ◽

Csf Lactate ◽

Aortic Aneurysm Surgery

Background Although ischemic injury to the spinal cord is a well-known complication of aortic surgery, no metabolic markers have been identified as predictors of an adverse outcome. This study evaluated the effect of cerebrospinal fluid (CSF) drainage, with and without distal femoral perfusion or moderate hypothermia on blood and CSF lactate concentrations and CSF pressure during thoracoabdominal aortic aneurysm surgery. Methods Three nonconcurrent groups of patients were studied prospectively: patients with normal body temperature (35 degrees C) but without distal femoral bypass (n = 6), patients with normal body temperature with bypass (n = 7), and patients with hypothermia (30 degrees C) and bypass (n = 8). In all patients, CSF pressure was recorded before, during, and after aortic cross-clamping. During the surgical repair, CSF drainage was performed using a 4-Fr intrathecal silicone catheter. Blood and CSF lactate concentrations were measured throughout the operation. Results Significant increases in blood (490%) and CSF (173%) lactate concentrations were observed during and after thoracic aortic occlusion in patients with normothermia and no bypass (P < 0.02 and 0.05, respectively). Distal perfusion attenuated the increase in both blood and CSF lactate (P < 0.01), and a further reduction was achieved with hypothermia of 30 degrees C (P < 0.001). Patients who became paraplegic showed a greater increase in CSF lactate concentrations after aortic clamp release compared with those who suffered no neurological damage (275% vs. 123% of baseline; P < 0.05). Increased CSF pressure of 42-60% (P < 0.005) was noted soon after thoracic aortic occlusion, both with and without distal femoral bypass. Conclusions Incremental reductions in CSF lactate concentrations were achieved using distal femoral bypass and hypothermia. The reduction in CSF lactate correlated with the methods used to protect the spinal cord during thoracoabdominal aortic aneurysm surgery and was associated with better outcome. Decompression by distal bypass of the hemodynamic overload caused by aortic occlusion was insufficient to eliminate the acute increase in CSF pressure. Cerebrospinal fluid lactate measurements during high aortic surgery may accurately represent the spinal cord metabolic balance.

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