Ischemic transverse myelopathy after endovascular repair of a thoracic aortic aneurysm.
OBJECTIVE
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.


METHODS
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.
Reichart
M
M
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Balm
R
R
Meilof
J F
JF
de Haan
P
P
Reekers
J A
JA
Jacobs
M J
MJ
D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D020760:Spinal Cord Ischemia / Q000209:etiology*