Korean Circ J.  2011 Mar;41(3):160-163. 10.4070/kcj.2011.41.3.160.

A Case of Paraplegia Following Endovascular Stent Repair of Descending Thoracic Aortic Aneurysm

• Lee MY
• Lee MG
• Hong KS
• Lee CY
• Park KT
• Lee CW
• Ryu MS
• Kim YM
• Hwang DH

• KMID: 2225132
• DOI: http://doi.org/10.4070/kcj.2011.41.3.160

Abstract

Paraplegia secondary to spinal cord infarction is a recognized complication of open thoracic and thoracoabdominal aortic aneurysm (TAA) repair. TAA is serious and unpredictable condition. Therefore, aortic repair requires thorough information on managing the potential complications will facilitate improve control the problem. We report the symptoms and management of paraplegia in a patient who underwent stent insertion as TAA.

Keyword

Stents; Spinal cord ischemia; Aortic aneurysm, abdominal

MeSH Terms

Aortic Aneurysm, Abdominal
Aortic Aneurysm, Thoracic
Humans
Infarction
Paraplegia
Spinal Cord
Spinal Cord Ischemia
Stents

Figure

• 

  Fig. 1 A 76-year-old man presented with chronic aortic aneurysm. A and B: enhanced CT scan shows thrombosed saccular aneurysm of the descending thoracic aorta (white arrow). C and D: CT scan sagittal view shows atherosclerosis of the aorta and thrombosed dissection (white arrow).

• 

  Fig. 2 Thoracic aortogram obtained in a 76-year-old man who underwent endovascular treatment for penetrating descending aorta (black arrow).

• 

  Fig. 3 Magnetic resonance imaging (MRI) scan showing spinal cord ischemia. A: sagittal T2W1 MRI shows area of abnormality from T6 to 12 (white arrows). B: area of abnormality noted predominantly in the anterior aspect of the cord, T6 to 12 (white arrow).

Reference

1. Sullivan TM, Sundt TM 3rd. Complications of thoracic aortic endografts: spinal cord ischemia and stroke. J Vasc Surg. 2006; 43(Suppl A):85A–88A.

2. Fattori R, Napli G, Lovato L, et al. Descending thoracic aortic diseases: stent-graft repair. Radiology. 2003; 229:176–183. PMID: 12902611.

3. Cheung AT, Pochettino A, McGarvey LM, et al. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms. Ann Thorac Surg. 2005; 80:1280–1289. PMID: 16181855.

4. 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; 16:509–512. PMID: 12134217.

5. Berg P, Kaufmann D, Marrewijk CJ, Buth J. Spinal cord ischaemia after stent-graft treatment for infra-renal abdominal aortic aneurysms: analysis of the Eurostar database. Eur J Vasc Endovasc Surg. 2001; 22:342–347. PMID: 11563894.

6. Choi JH, Lim C, Park KH, Chung ES, Kang SG, Yoon CJ. Percutaneous endovascular stent-graft treatment for aortic disease in high risk patients: the early and mid-term results. Korean J Thorac Cardiovasc Surg. 2008; 41:239–246.

7. Ahn CM, Choi DH, Shim WH. Endovascular abdominal aortic aneurysmal repair: a Korean perspective. Korean Circ J. 2007; 37:459–463.

8. Gowda RM, Misra D, Tranbaugh RF, Ohki T, Khan IA. Endovascular stent grafting of descending thoracic aortic aneurysms. Chest. 2003; 124:714–719. PMID: 12907563.

9. Zuber WF, Gasper MR, Rothschild PD. The anterior spinal artery syndrome: a complication of abdominal aortic surgery: report of five cases and review of the literature. Ann Surg. 1970; 172:909–915. PMID: 5477667.

10. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2002; (3):CD001046. PMID: 12137616.

11. Weigang E, Hartert M, von Samson P, et al. Thoracoabdominal aortic aneurysm repair: interplay of spinal cord protecting modalities. Eur J Vasc Endovasc Surg. 2005; 30:624–631. PMID: 16023390.

12. Lim KJ, Kwan TD, Jeon YS, Kim JS. Anesthetic management of endovascular stent graft placement for thoracic aortic diseases: a case report. Korean J Anesthesiol. 2005; 49:106–110.

13. Grabenwöger M, Hutschala D, Ehrlich MP, et al. Thoracic aortic aneurysms: treatment with endovascular self-expandable stent grafts. Ann Thorac Surg. 2000; 69:441–445. PMID: 10735678.

14. Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Caronno R, Castelli P. Complications after endovascular stent-grafting of thoracic aortic diseases. J Cardiothorac Surg. 2006; 1:26. PMID: 16968547.