Spinal Cord Ischemia after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: A Rare Complication

Abstract

Neurologic deficit secondary to spinal cord ischemia after elective infrarenal, endovascular aneurysm repair (EVAR), consists a rare and rather disastrous complication. The etiology of such neurologic complication seems to be multifactorial, making this event unpredictable and foremost unpreventable. We report a case of paraparesis and bladder dysfunction that occurred immediately after the EVAR procedure. Prompt management by conservative or invasive methods seems to be important for the reversal of the neurologic deficit and the optimization of patient's outcome.

Sonographic Changes in Optic Nerve Sheath Diameter Associated with Supra‐ versus Infrarenal Aortic Aneurysm Repair

“…Patients undergoing iAAR have a significantly lower risk of developing a fatal increase in ISP due to spinal ischemia than patients undergoing sAAR. 6 The hypothesis that patients in the two groups would feature different courses of ONSD changes as an indirect marker for ISP could be confirmed in our prospective study: we demonstrated significant changes in ONSD after EVAR of sAA (increase, P = .006) and EVAR of iAA (decrease, P = .02). A relevant difference between both groups was also evident in the baseline ONSD values with higher mean values in iAAR patients (5.3 (SD .4) mm vs. 4.9 (SD .64 mm).…”

“…In contrast to Group sAAR, no patients in Group iAAR received a spinal catheter because of the low odds of SCI following iAAR (<.1%). 6 Patients characteristics, durations of interventions, and information regarding spinal catheters are given in Table 1.…”

“…The length of the aorta covered by a stent seems to be associated with a higher risk for paraplegia . In correlation with the patient's vascular supply and the length of the covered aorta, infrarenal AAR (iAAR) is associated with only a marginal risk for spinal ischemia …”

“…4,5 In correlation with the patient's vascular supply and the length of the covered aorta, infrarenal AAR (iAAR) is associated with only a marginal risk for spinal ischemia. 6 Intraspinal pressure in conjunction with arterial blood pressure defines spinal cord perfusion pressure. We previously demonstrated that changes in spinal cerebrospinal fluid (CSF) pressure following suprarenal EVAR can be monitored using sonographic measurements of the optic nerve sheath diameter (ONSD).…”

Hypogastric artery thrombectomy for spinal cord ischemia following fenestrated endovascular aortic repair

“… 1 , 2 , 3 , 4 Specifically, for patients with longer aortic stent graft coverage, occlusion of the intercostal arteries and collateral network around the spinal cord will result in a higher risk of SCI. 4 , 5 , 6 …”