title: Posterior reversible encephalopathy syndrome from induced hypertension during endovascular thoracoabdominal aortic aneurysm repair.
abstract: Endovascular repair of thoracoabdominal aortic aneurysm has been increasingly performed using fenestrated and branched endografts. Spinal cord injury is a complication of complex endovascular aortic repair, especially in patients with extensive aortic involvement. Maneuvers commonly used to avoid spinal cord injury include cerebrospinal fluid drainage and induced hypertension. Posterior reversible encephalopathy syndrome is associated with abnormal cerebral autoregulation through endothelial and blood-brain barrier dysfunction; the pathophysiology involves vasogenic edema, and severe hypertension is a recognized trigger. We report on a patient who developed posterior reversible encephalopathy syndrome associated with induced hypertension used to prevent spinal cord injury during endovascular repair of a type II thoracoabdominal aortic aneurysm using fenestrated and branched stent grafts.
authors.affiliation: Gonda Vascular Center, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: oderich.gustavo@mayo.edu.
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.affiliation: Gonda Vascular Center, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Alexandre A
authors.initials: AA
authors.lastname: Pereira
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minn.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Gonda Vascular Center, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Bernardo C
authors.initials: BC
authors.lastname: Mendes
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minn.
authors.forename: Juan N
authors.initials: JN
authors.lastname: Pulido
mesh_terms: D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001794:Blood Pressure; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D011474:Prosthesis Design; D013119:Spinal Cord Injuries / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome