A report of spinal cord ischemia following endovascular aneurysm repair of an aneurysm with a large thrombus burden and complex iliac anatomy

Vascular and Endovascular Surgery
Christos LioupisDomenico Valenti

Abstract

We report a case of paraplegia occurring after an elective endovascular aneurysm repair (EVAR) that was reversed by cerebrospinal fluid (CSF) drainage. This case report highlights the reality that the endovascular management of abdominal aortic aneurysms (AAAs) with large volumes of mural thrombus and complex iliac anatomy can be complicated by spinal cord ischemia (SCI). The presumed mechanism of SCI is dissemination of atherosclerotic material during protracted catheter and wire manipulations. Embolization of internal iliac arteries (IIAs), profunda femoral arteries, and possibly other arterial networks may explain the delayed presentation. The complex iliac anatomy necessitating covering of one and reconstruction of the other hypogastric artery and the prolonged operative time may be 2 other contributing factors. The prompt CSF drainage may reverse the neurologic deficit.

References

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Citations

Jul 19, 2011·Case Reports in Medicine·George N KouvelosMiltiadis I Matsagkas
Jan 12, 2016·Annals of Cardiac Anaesthesia·Harikrishnan KothandanShah Shitalkumar Sharad
May 31, 2011·Annals of Vascular Surgery·Domenico AngilettaGuido Regina
Nov 26, 2010·Journal of Cardiothoracic and Vascular Anesthesia·Todd J SmakaDavid A Lubarsky
Jul 28, 2011·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Bassem ChehabKamal Gupta
Nov 2, 2016·Journal of Neurosurgery. Spine·Lisa B E ShieldsChristopher B Shields

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