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Spinal Cord ischaemia: case report An 82-year-old man developed spinal cord ischaemia following the administration of ethiodized oil during emobolisation. The man presented to a hospital with a history of endovascular abdominal aortic aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA) associated to a type II endoleak. Examinations showed a 5mm growth of the aneurysm within the previous 9 months. Further examinations showed a type II-endoleak from the inferior mesenteric artery. As no connection between the two leaks was identified, coil embolisation was performed to avoid sigmoid ischaemia. Additionally, subsequent injections from the suprarenal aorta highlighted a voluminous left lumbar branch that originated from the aortic neck, which was partially covered by the sealing tract of the stent graft. A selective angiography confirmed the presence of type-II endoleak from the lumbar arteries. Subsequently, he underwent embolisation of both the lumbar branches involved in the endoleak with ethiodized oil [Glubran-lipiodol glue] with a dilution of 1:5 [dosage and route not stated]. However, a few hours after the procedure, he developed paraplegia. An urgent MRI showed an ischaemic lesion (hyperintensity of the medullary signal and mild edema) between D11 and L1, which involved the anterior two-thirds of the spinal cord [time to reaction onset not stated]. The man was treated with methylprednisolone and CSF drainage. During follow-up examination (in-hospital and after 2 months), mild clinical improvement was noted with bilateral minimal hip and knee flexion. Contrast-enhanced echography showed aneurysm sealing during follow-up examination after 2 months. Author comment: "In our case, 2 facts might explain the spinal cord ischemia: (1) spinal cord hypoperfusion due to proximal occlusion of unexpected critical lumbar arteries; (2) medullary vasculature embolization due to migration of [Ethiodized-oil], the latter being our most suspected hypothesis." Sanz-Sanchez J, et al. Paraplegia Due to Spinal Cord Ischemia after Endovascular Treatment of a Type II Endoleak. Annals of Vascular Surgery 61: 472e1-472e3, Nov 2019. Available from: URL: http://doi.org/10.1016/j.avsg.2019.05.054 803442255 Italy

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Reactions 4 Jan 2020 No. 1785