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Paraplegia secondary to spinal cord ischaemia > Following Elective Stent-graft Repair of Abdominal Aortic Aneurysm AAA > Devastating complication of Endovascular Repair for AAA > Reversal with Cerebrospinal Fluid Drainage

Are endovascular techniques prone to similar complications as open aneurysm surgery? Is Paraplegia secondary to spinal cord ischemia a complication of stent-graft repair for abdominal aortic aneurysm? Can the immediate insertion of a cerebrospinal fluid CSF drain result in full neurological recovery?

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IIP > Read on here…

Spinal cord ischaemia resulting in paraplegia or paraparesis following elective abdominal aortic aneurysm (AAA) repair is a rare complication with catastrophic consequences. The estimated incidence in open aneurysm repair surgery is 1 in 400 and 1 in 5000 following surgery for occlusive aortoiliac disease…

Recent reports have highlighted complications that may be encountered with endovascular repair, including spinal cord ischaemia…

An 83 year old man presented with an incidental finding of a 6 cm infrarenal AAA. Contrast enhanced CT showed the aneurysm to be suitable for endovascular repair with a good proximal neck but the common iliac arteries were ectatic and calcified with tortuous calcified external iliac arteries…

At a further operation a Cook Zenith aorto uniliac device was deployed via the right ilio-femoral conduit under epidural anaesthesia. Completion angiogram showed no evidence of an endoleak. In recovery the patient developed paraplegia, with a sensory loss to the level of T6 on the right and T4 on the left with complete loss of motor power to T4. A CSF drain was immediately inserted in the L3-L4 space and the epidural catheter was removed. Within one hour the neurological deficit had resolved completely. The CSF drain was removed 48 hours post insertion.

Three days post EVAR balloon angioplasty of a stenosis at the origin of the right internal iliac artery was performed, in order to optimise the patient’s pelvic circulation, and reduce the risk of paraplegia on withdrawal of the CSF drain. The patient was discharged on day five with no further complications…

This case report highlights that patients undergoing EVAR are susceptible to spinal cord ischaemia, a complication with high morbidity and mortality. Analysis of the European collaborators on stent graft techniques for abdominal aortic aneurysm repair (EUROSTAR) database of 2862 patients who had undergone EVAR found an incidence of 0.21% for spinal cord ischaemia…

In conclusion prompt CSF drainage is advised if spinal cord ischaemia is suspected in such patients. Delay in inserting the CSF drain in order to image the spinal cord for haematoma may reduce the efficacy in reversing the neurological deficit. Investigations, such as MRI or CT of the spine, should be only be arranged once a spinal drain is in place, especially as many of these scans are normal in the acute phase. CSF drainage without delay is the most likely intervention to have any benefit in this devastating complication of aortic endovascular therapy.

This was written by admin. Posted on Tuesday, January 20, 2009, at . 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