title: Surgical repair following trauma to vascular graft causing spinal cord infarction.
abstract: A 55-year-old woman with a background of vascular disease presented with signs of bilateral limb ischaemia. Following elective axillobifemoral bypass and hospital discharge, accidental axillary trauma causing a chest wall haematoma, the patient underwent an emergency graft repair. Postextubation, she reported with absent sensation in her legs. Spinal cord infarction was diagnosed through clinical assessment and exclusion of other causes. The aetiology of compromise to the spinal cord blood supply is unclear. Possibilities include intraoperative hypotension, inadvertent compromise to blood supply of thoracic radicular arteries, dislodged atherosclerotic emboli or a combination of these factors. Spinal cord infarction recognised early can be treated. Sedation to assist ventilation had obscured the problem early enough to consider treatment. Patients with vascular risk factors should be carefully managed intraoperatively to minimise hypotensive episodes and care should also be taken not to compromise blood flow of radicular arteries.
authors.affiliation: Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Sayinthen
authors.initials: S
authors.lastname: Vivekanantham
authors.forename: Gokulan
authors.initials: G
authors.lastname: Phoenix
authors.forename: Chetan
authors.initials: C
authors.lastname: Khatri
authors.forename: Saroj
authors.initials: S
authors.lastname: Das
mesh_terms: D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007238:Infarction / Q000209:etiology*; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000601:surgery*; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000209:etiology*; D013898:Thoracic Injuries / Q000150:complications*; D058017:Vascular Grafting; D057772:Vascular System Injuries / Q000150:complications*
references.citation: Arch Neurol. 2006 Aug;63(8):1113-20
references.pmid: 16908737
references.citation: Arch Orthop Trauma Surg. 2005 Feb;125(1):33-41
references.pmid: 15616819
references.citation: Paraplegia. 1994 May;32(5):314-22
references.pmid: 8058348
references.citation: Ann Thorac Surg. 2010 Aug;90(2):561-5
references.pmid: 20667350
references.citation: J Vasc Surg. 1986 Jan;3(1):94-103
references.pmid: 3941486
references.citation: J Clin Anesth. 2004 Sep;16(6):440-4
references.pmid: 15567648
references.citation: Neuroradiology. 2002 Oct;44(10):851-7
references.pmid: 12389137
references.citation: Stroke. 2002 Jan;33(1):116-21
references.pmid: 11779899
references.citation: Adv Card Surg. 1993;4:89-107
references.pmid: 8252259
references.citation: Eur J Cardiothorac Surg. 2007 Apr;31(4):637-42
references.pmid: 17306553
references.citation: Ann Cardiothorac Surg. 2012 Sep;1(3):365-72
references.pmid: 23977522
references.citation: J Vasc Surg. 2011 Sep;54(3):677-84
references.pmid: 21571494
references.citation: Sultan Qaboos Univ Med J. 2010 Dec;10(3):396-400
references.pmid: 21509262
references.citation: Anesth Analg. 2012 Jun;114(6):1297-300
references.pmid: 22075019
references.citation: Ann Thorac Surg. 2007 Apr;83(4):1345-55; discussion 1355
references.pmid: 17383338
references.citation: Acta Anaesthesiol Scand. 2002 Apr;46(4):469-72
references.pmid: 11952453
references.citation: Acta Anaesthesiol Belg. 2008;59(2):95-8
references.pmid: 18652107
references.citation: Medicine (Baltimore). 1989 Sep;68(5):282-92
references.pmid: 2677596
references.citation: J Card Surg. 2012 Jan;27(1):45-6
references.pmid: 21992605
references.citation: Acta Med Iran. 2011;49(8):560-4
references.pmid: 22009815
references.citation: Eur Spine J. 2005 Nov;14(9):906-9
references.pmid: 15937672