Neurologic Injury after Endovascular StentGraft and Bilateral Internal Iliac Artery Embolization for Infrarenal Abdominal Aortic Aneurysm

Significant CIA ectasia or small aneurysm is often associated with AAA. In such cases, the bell-bottom procedure that preserves IIA circulation is a new alternative to the common practice of placement of endograft extensions across the iliac artery bifurcation in patients with at least one CIA diameter of less than 26 mm. Additional benefits include reduced total procedure time. Early technical success appears to justify continued use. However, long-term evaluation is necessary to determine durability because the risk of rupture as the result of potential expansion of the excluded iliac artery or late failure is unknown.

mentioning

confidence: 99%

Bell-bottom aortoiliac endografts: An alternative that preserves pelvic blood flow

Kritpracha¹,

Pigott²,

Russell³

et al. 2002

“…6,11 Additional factors implicated in SCI after EVAR include intentional or inadvertent coverage of one or both hypogastric arteries, and atheroembolization due to wire manipulation. 5,12,13 This patient had two significant anatomic compromises to the spinal cord circulation: the endograft was situated more proximally than is customary (originating at the level of the SMA potentially covering more lumbar arteries), and one hypogastric artery was electively embolized at its origin. There were no prominent lumbar arteries or a patent IMA noted on initial angiography before endograft deployment (Fig 4).…”

Section: Discussionmentioning

confidence: 99%

“…The time courses exhibited by our patient and that reported by Reid et al 15 reiterate the precarious blood supply to the spinal cord after elective coverage of the IMA and lumbar arteries after EVAR. Both patients were suffering from renal failure and exhibited acute hypoperfusion secondary to dehydra- 13 the hypogastric collateral circulation is critical to the perfusion of the spinal cord after EVAR. The combination of a high proximal graft placement, and unilateral hypogastric artery embolization left a tenuous collateral supply to this patient's spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Delayed permanent paraplegia after endovascular repair of abdominal aortic aneurysm

Goldstein

Rezayat

Shrikhande

et al. 2010

Spinal cord ischemia is a rare complication after abdominal aortic surgery and has been attributed to surgical devascularization of the spinal cord, atheroembolization of the cord circulation, or hypoperfusion of cord structures secondary to hypotension or cord edema. We present a diabetic, hypertensive 75-year-old male with endstage renal disease who presented with a 5.5 cm asymptomatic infrarenal abdominal aortic aneurysm, and concomitant 3.5 cm right common iliac artery aneurysm. After undergoing successful endovascular repair with an aorto-uni-iliac device, unilateral hypogastric artery embolization, and femoral-femoral bypass, he was discharged to a rehabilitation facility neurologically intact with a stage 2 decubitus ulcer. He returned on postoperative day 21 with a large stage 4 septic decubitus ulcer, fever, leukocytosis, hypotension, and paraplegia. We hypothesize that the compromised blood flow from the initial reconstruction, combined with the delayed hypotension imposed by sepsis, resulted in spinal cord infarction. He was eventually discharged to a nursing facility with no improvement in his neurologic status. We report the first case of significantly delayed permanent paraplegia after endovascular abdominal aortic aneurysmorrhaphy.

“…In another previous study, stent grafting to treat an abnormal aortic aneurysm along with embolization of the iliac arteries was complicated by lower extremity weakness and fecal incontinence in one patient. 18 John et al 19 reported a patient with sciatic neuropathy after endovascular treatment of a limb vascular malformation.…”

Section: Discussionmentioning

confidence: 99%

Incidence of soft tissue injury and neuropathy after embolo/sclerotherapy for congenital vascular malformation

Lee

Kim

et al. 2008

Soft tissue injuries occurred in 11.9% of patients (68 of 573) and neuropathies occurred in 8.6% (49 of 573) after undergoing embolo/sclerotherapy. Most of these complications recovered by themselves (58.9% from soft tissue injury and 85.1% from neuropathy). Our results suggest that embolo/sclerotherapy has an acceptable incidence of soft tissue injury and neuropathy, when considering the effect that the CVM had on the quality of life before treatment, so embolo/sclerotherapy is recommended as a treatment modality for CVM.