Ischemic Transverse Myelopathy after Endovascular Repair of a Thoracic Aortic Aneurysm

Abstract

Purpose:

To report a dramatic complication after endovascular repair of a descending thoracic aortic aneurysm (TAA) and to present a classification system and possible methods to avoid spinal cord ischemia.

Case Report:

A 48-year-old man with a descending TAA between T5 and T9 was treated with endovascular stent-grafts. Fourteen hours after the operation, the patient developed partial transverse myelopathy at level T10. During emergency conversion to open surgery and implantation of a conventional tube graft, 3 intercostal arteries that had been covered by the stent-graft were revascularized. Postoperatively, the neurological deficit improved, and the patient was able to walk again. Methods to predict and possibly prevent the induction of spinal cord ischemia after endovascular repair of TAA are suggested.

Conclusions:

Endovascular repair of TAA may induce spinal cord ischemia; pre- and intraoperative assessment of involved intercostal arteries should be performed.

Keywords

endograft Excluder stent-graft spinal cord ischemia motor-evoked potentials paraplegia

Get full access to this article

View all access options for this article.

References

Fann

Miller

. Endovascular treatment of descending thoracic aortic aneurysms and dissections. Surg Clin North Am. 1999;79:551–574.

Nienaber

Fattori

Lund

. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999;340:1539–1545.

Ehrlich

Grabenwoeger

Cartes-Zumelzu

. Endovascular stent graft repair for aneurysms on the descending thoracic aorta. Ann Thorac Surg. 1998;66:19–25.

Mitchell

Miller

Dake

. Thoracic aortic aneurysm repair with an endovascular stent graft: the “first generation.” Ann Thorac Surg. 1999;67:1971–1974.

Greenberg

Resch

Nyman

. Endovascular repair of descending thoracic aortic aneurysms: an early experience with intermediate-term follow-up. J Vasc Surg. 2000;31:147–156.

Umana

Mitchell

. Endovascular treatment of aortic dissections and thoracic aortic aneurysms. Semin Vasc Surg. 2000;13:290–298.

Temudom

D'Ayala

Marin

. Endovascular grafts in the treatment of thoracic aortic aneurysms and pseudoaneurysms. Ann Vasc Surg. 2000;14:230–238.

de Haan

Kalkman

de Mol

. Efficacy of transcranial motor-evoked myogenic potentials to detect spinal cord ischemia during operations for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg. 1997;113:87–100.

Safi

Subramaniam

Miller

. Progress in the management of type I thoracoabdominal and descending thoracic aortic aneurysms. Ann Vasc Surg. 1999;13:457–462.

10.

Verdant

Cossette

Pagé

. Aneurysms of the descending thoracic aorta: three hundred sixty-six consecutive cases resected without paraplegia. J Vasc Surg. 1995;21:385–391.

11.

Byrne

Waxman

. Paraplegia and spinal cord syndromes. In: Bradley

Daroff

Fenichel

, eds. Neurology in Clinical Practice: Principles in Diagnosis and Management. 2nd ed. Boston: Butterworth-Heinemann; 1996:345–358.

12.

Kieffer

Richard

Chiras

. Preoperative spinal cord arteriography in aneurysmal disease of the descending thoracic and thoracoabdominal aorta: preliminary results in 45 patients. Ann Vasc Surg. 1989;3:34–46.

13.

Jacobs

MJHM

Meylaerts

de Haan

. Strategies to prevent neurologic deficit based on motor-evoked potentials in type I and II thoracoabdominal aortic aneurysm repair. J Vasc Surg. 1999;29:48–59.

14.

Ishimaru

Kawaguchi

Koizimi

. Preliminary report on prediction of spinal cord ischemia in endovascular stent-graft repair of thoracic aortic aneurysm by retrievable stent graft. J Thorac Cardiovasc Surg. 1998;115:811–818.

15.

Balm

Reekers

Jacobs

MJHM

. Classification of endovascular procedures for treating thoracic aortic aneurysms. In: Jacobs

MJHM

Branchereau

, eds. Surgical and Endovascular Treatment of Aortic Aneurysms. New York: Futura Publishing Company; 2000:19–26.