title: Delayed permanent paraplegia after endovascular repair of abdominal aortic aneurysm.
abstract: Spinal cord ischemia is a rare complication after abdominal aortic surgery and has been attributed to surgical devascularization of the spinal cord, atheroembolization of the cord circulation, or hypoperfusion of cord structures secondary to hypotension or cord edema. We present a diabetic, hypertensive 75-year-old male with endstage renal disease who presented with a 5.5 cm asymptomatic infrarenal abdominal aortic aneurysm, and concomitant 3.5 cm right common iliac artery aneurysm. After undergoing successful endovascular repair with an aorto-uni-iliac device, unilateral hypogastric artery embolization, and femoral-femoral bypass, he was discharged to a rehabilitation facility neurologically intact with a stage 2 decubitus ulcer. He returned on postoperative day 21 with a large stage 4 septic decubitus ulcer, fever, leukocytosis, hypotension, and paraplegia. We hypothesize that the compromised blood flow from the initial reconstruction, combined with the delayed hypotension imposed by sepsis, resulted in spinal cord infarction. He was eventually discharged to a nursing facility with no improvement in his neurologic status. We report the first case of significantly delayed permanent paraplegia after endovascular abdominal aortic aneurysmorrhaphy.
authors.affiliation: Division of Vascular Surgery, The DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami Jackson Memorial Medical Center, Miami, Fla, USA.
authors.forename: Lee J
authors.initials: LJ
authors.lastname: Goldstein
authors.forename: Combiz
authors.initials: C
authors.lastname: Rezayat
authors.forename: Gautam V
authors.initials: GV
authors.lastname: Shrikhande
authors.forename: Harry L
authors.initials: HL
authors.lastname: Bush
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007022:Hypotension / Q000209:etiology; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010264:Paraplegia / Q000209:etiology*; D018805:Sepsis / Q000209:etiology; D020760:Spinal Cord Ischemia / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome