Spinal cord ischemia after endovascular embolization of a type II endoleak following endovascular aneurysm repair.
BACKGROUND
We report a rare case of severe spinal cord ischemia with neurological consequences in a patient who presented after endovascular treatment of a type II endoleak following endovascular aneurysm repair.


RESULTS
An enlarging abdominal aortic aneurysm post-endovascular aneurysm repair was detected owing to a persistent type II endoleak caused by a communication between the iliolumbar and L4 lumbar artery for which the patient underwent supraselective embolization with particles and coils. Immediately after the procedure, the patient experienced an acute onset of neurological symptoms in the right lower limb while limb arterial perfusion remained unaffected. Magnetic resonance imaging-magnetic resonance angiography revealed an acute ischemic process at the L2-L4 level. Further follow-up revealed persistence of the endoleak, and the patient was referred to our institution for open surgical treatment.


CONCLUSIONS
To the best of our knowledge, this is the first report of severe spinal cord ischemia after transcatheter embolization of the feeding iliolumbar branches of a type II endoleak. Care must be taken during embolization of the feeding artery of type II endoleaks, which may also supply the spinal cord, to minimize the risk of possible spinal cord ischemia.
Vascular Surgery Unit, University of Crete Medical School, Heraklion, Crete, Greece. ioannou@med.uoc.gr
Christos V
CV
Ioannou
Dimitrios K
DK
Tsetis
Dimitrios G
DG
Kardoulas
Pavlos G
PG
Katonis
Asterios N
AN
Katsamouris
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D020878:Device Removal; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D020335:Paraparesis / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000209:etiology; D012086:Reoperation; D012720:Severity of Illness Index; D020760:Spinal Cord Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color