title: A report of spinal cord ischemia following endovascular aneurysm repair of an aneurysm with a large thrombus burden and complex iliac anatomy.
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.
authors.affiliation: Department of Vascular Surgery, King's College Hospital, London, United Kingdom.
authors.forename: Christos
authors.initials: C
authors.lastname: Lioupis
authors.forename: Mark
authors.initials: M
authors.lastname: Tyrrell
authors.forename: Domenico
authors.initials: D
authors.lastname: Valenti
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003251:Constriction, Pathologic; D004322:Drainage / Q000379:methods; D017558:Elective Surgical Procedures; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D020760:Spinal Cord Ischemia / Q000209:etiology* / Q000628:therapy; D013129:Spinal Puncture; D017131:Thrombectomy; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome