title: Decision to Interrupt Second-Stage Side-Branch Completion in Thoracoabdominal Branched Aortic Stent Grafting to Prevent Spinal Cord Ischemia.
abstract: BACKGROUND
  Spinal cord ischemia (SCI) is a severe complication of extended endovascular repair of thoracoabdominal aneurysms. We describe voluntary interruption of side-branch completion in staged branched endovascular aneurysm treatment due to uncertainty regarding SCI possible onset, based on intraoperative angiography findings.
  
  
  METHODS
  We report a case of a staged endovascular treatment of thoracoabdominal aortic aneurysm in a 64-year-old patient using a branched endograft with an additional side branch that allows temporary sac perfusion to prevent SCI. The third operative step was intended to occlude the side branch. Intraoperative angiography through the side branch demonstrated circulating aneurysm sac, with patent inferior intercostal and superior lumbar arteries giving direct blood supply to a clearly visible anterior spinal artery. The procedure was stopped.
  
  
  RESULTS
  One month later, sac thrombosis occurred spontaneously and was clinically responsible for neurogenic claudication that resolved during follow-up.
  
  
  CONCLUSIONS
  Interrupting side-branch completion seems to have allowed additional ischemic conditioning of the spinal cord as the spontaneous sac thrombosis induced mild neurological event.
authors.affiliation: Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France. Electronic address: josephtouma.md@gmail.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Touma
authors.affiliation: Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France.
authors.forename: Bachir
authors.initials: B
authors.lastname: Benamara
authors.affiliation: Department of Interventional Radiology, Henri Mondor University Hospital, Créteil, France.
authors.forename: Hicham
authors.initials: H
authors.lastname: Kobeiter
authors.affiliation: Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Desgranges
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology; D008875:Middle Aged; D012039:Regional Blood Flow; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D015607:Stents; D016896:Treatment Outcome