title: Reversal of delayed-onset paraparesis after revision thoracic endovascular aortic repair for ruptured thoracic aortic aneurysm.
abstract: Thoracic endovascular aortic repair (TEVAR) is an important surgical option for the emergency treatment of ruptured thoracic aortic aneurysms, but is associated with a risk of spinal cord ischemia (SCI). Although risk factors for the development of SCI have been well described, the effectiveness of treatment to increase spinal cord perfusion pressure remains incompletely understood. We report the successful treatment of delayed-onset paraparesis after revision TEVAR for acute descending thoracic aortic rupture with the combined use of blood pressure augmentation and cerebrospinal fluid drainage. The clinical manifestations, pathophysiology, and management of SCI after TEVAR are reviewed.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Brant W
authors.initials: BW
authors.lastname: Ullery
authors.forename: Albert T
authors.initials: AT
authors.lastname: Cheung
authors.forename: Michael L
authors.initials: ML
authors.lastname: McGarvey
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
mesh_terms: D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004322:Drainage; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D008297:Male; D020335:Paraparesis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013129:Spinal Puncture; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents