Abstract
Background: The etiology of delayed-onset spinal cord injury (SCI) following endovascular repair of thoraco-abdominal aortic aneurysms (TAAA) is still unclear and may be related to multiple factors. Extravascular factors, such as lumbar spinal stenosis (LSS), may play a significant role in the selection of patient at risk of SCI. In this report we describe a case of paraplegia following thoracic endovascular aortic repair (TEVAR) in a patient suffering from severe and symptomatic LSS and undergoing staged endovascular repair of a TAAA.Case presentation: A 70-year-old man was admitted to our department with an asymptomatic type III TAAA in previous open repair for abdominal aortic aneurysm. The patient complained of buttock and thigh claudication in the absence of defects in the pelvic perfusion; a spinal magnetic resonance angiography (MRA) showed a severe narrowing of the lumbar canal. The first-step procedure was estimated at intermediate risk of SCI and considering a recent cardiac procedure requiring double antiplatelet therapy, in agreement with anesthesiologists, a preoperative cerebrospinal fluid (CSF) drainage was not performed during the first-step. After 24 hours from TEVAR paraplegia was detected. The drainage was then placed with incomplete recovery. The second stage was performed in urgency three weeks after, without complications and changes in neurological status.Conclusions: Stenotic damage to the spinal cord is thought to be the result of direct compression of the neural elements and ischemic disruption of arterial and venous structures surrounding the spinal cord. This comorbidity may constitute an additional anatomic risk factor in those patients currently recognized as prognostically associated to the development of SCI.
Rehabilitation for Spinal Cord Injury Caused by Thoracic Aortic Aneurysm