Extravascular risk factors in the prognostic evaluation for spinal cord injury during thoraco-abdominal aortic aneurysm exclusion: a case report

Flavio Villani,Aaron Thomas Fargion,Rossella Di Domenico,Davide Esposito,Walter Dorigo,Carlo Pratesi,Alberto Melani

doi:10.1186/s13019-020-01358-x

Flavio Villani, Aaron Thomas Fargion + Show 5 more

Open Access

https://doi.org/10.1186/s13019-020-01358-x

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Abstract

BackgroundThe etiology of delayed-onset spinal cord injury (SCI) following endovascular repair of thoraco-abdominal aortic aneurysms (TAAA) is still unclear and may be related to multiple factors. Extravascular factors, such as lumbar spinal stenosis (LSS), may play a significant role in the selection of patient at risk of SCI. In this report we describe a case of paraplegia following thoracic endovascular aortic repair (TEVAR) in a patient suffering from severe and symptomatic LSS and undergoing staged endovascular repair of a TAAA.Case presentationA 70-year-old man was admitted to our department with an asymptomatic type III TAAA in previous open repair for abdominal aortic aneurysm. The patient complained of buttock and thigh claudication in the absence of defects in the pelvic perfusion; a spinal magnetic resonance angiography (MRA) showed a severe narrowing of the lumbar canal.. After 24 h from first-step procedure (TEVAR) paraplegia was detected. A cerebrospinal fluid (CSF) drainage was then placed with incomplete recovery.ConclusionsStenotic damage to the spinal cord is thought to be the result of direct compression of the neural elements and ischemic disruption of arterial and venous structures surrounding the spinal cord. This comorbidity may constitute an additional anatomic risk factor in those patients currently recognized as prognostically associated to the development of SCI.

Highlights

The etiology of delayed-onset spinal cord injury (SCI) following endovascular repair of thoracoabdominal aortic aneurysms (TAAA) is still unclear and may be related to multiple factors
This comorbidity may constitute an additional anatomic risk factor in those patients currently recognized as prognostically associated to the development of SCI
Among the factors which could potentially increase the risk of SCI, the concomitant presence of stenosis of the lumbar canal has been anecdotally reported in previous papers regarding conventional open repair of TAAA [4]; we are not aware of other studies describing such an association in patients undergoing endovascular treatment

Summary

Conclusions

Stenotic damage to the spinal cord is thought to be the result of direct compression of the neural elements and ischemic disruption of arterial and venous structures surrounding the spinal cord.

Findings

Background

Discussion and conclusions