Extravascular risk factors in the prognostic evaluation for spinal cord injury during thoraco-abdominal aortic aneurysm
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(2020) 15:320
CASE REPORT
Open Access
Extravascular risk factors in the prognostic evaluation for spinal cord injury during thoraco-abdominal aortic aneurysm exclusion: a case report Flavio Villani* , Aaron Thomas Fargion, Alberto Melani, Davide Esposito, Rossella Di Domenico, Walter Dorigo and Carlo Pratesi
Abstract Background: The etiology of delayed-onset spinal cord injury (SCI) following endovascular repair of thoracoabdominal 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.. After 24 h from first-step procedure (TEVAR) paraplegia was detected. A cerebrospinal fluid (CSF) drainage was then placed with incomplete recovery. 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. Keywords: Collateral network, Endograft, Spinal cord ischemia, Lumbar spinal stenosis, Thoraco-abdominal aortic aneurysm, Thoracic endovascular aortic repair, Case report
Background Paraplegia secondary to spinal cord injury (SCI) remains a devastating complication following endovascular coverage of the thoracic aorta, with a reported risk of up to 20% during endovascular repair of extensive thoracoabdominal aortic aneurysms (TAAA) [1, 2]. SCI can occur not only intraoperatively but also postoperatively, * Correspondence: [email protected] Department of Vascular Surgery, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
causing delayed-onset paraplegia (usually within the first 24–48 h). While the etiology of acute SCI probably lies in a state of hypoxic injury due to spinal cord hypoperfusion or collateral vessels embolism, the causes of delayed-onset SCI are still unclear and may be related to multiple factors. In order to reduce the incidence of SCI, a staged approach has been suggested [3], even though it does not represent the only available technique adopted to avoid such a complication. One of the proposed staged approaches consists of thoracic endovascular
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International Licens
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