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.
MeSH terms
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Aortic Aneurysm, Abdominal / complications
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Aortic Aneurysm, Abdominal / diagnostic imaging
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Aortic Aneurysm, Abdominal / surgery*
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Aortography / methods
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Arterial Occlusive Diseases / complications
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Arterial Occlusive Diseases / diagnostic imaging
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Arterial Occlusive Diseases / surgery*
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Blood Vessel Prosthesis Implantation / adverse effects*
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Constriction, Pathologic
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Drainage / methods
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Elective Surgical Procedures
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Embolism / diagnostic imaging
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Embolism / etiology*
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Embolism / therapy
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Humans
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Iliac Aneurysm / complications
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Iliac Aneurysm / diagnostic imaging
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Iliac Aneurysm / surgery*
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Iliac Artery / diagnostic imaging
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Iliac Artery / surgery*
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Male
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Middle Aged
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Paraplegia / etiology
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Spinal Cord Ischemia / etiology*
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Spinal Cord Ischemia / therapy
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Spinal Puncture
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Thrombectomy
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Thrombosis / complications
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Thrombosis / diagnostic imaging
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Thrombosis / surgery*
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Tomography, X-Ray Computed
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Treatment Outcome