Sudden-Onset Paraplegia and Ischemia of the Lower Extremities from Acute Aortic Occlusion following Type A Acute Dissection

Abstract

Herein, we report the case of a 51-year-old man who presented with sudden-onset paraplegia and ischemia of lower extremities, with low back pain. CT scanning revealed Type A acute dissection with occlusion of the infrarenal abdominal aorta and bilateral iliac arteries. A lumbar catheter was inserted for cerebrospinal fluid drainage and we repaired Type A aortic dissection with ascending aorta and total arch replacement combined with stent-graft elephant trunk technique by using innominate cannulation and an aorto-femoral bypass. On postoperative day three, ischaemic symptoms including paraplegia totally disappeared and he was discharged from the hospital on postoperative day 44. not restored. Finally, an aorto-femoral bypass was performed using an 8-mm Gore-Tex Vascular Graft (W.L. Gore & Associates, Inc., Flagstaff, AZ, USA) in an end-to-end fashion to 1 limb of the 4-branch prosthetic graft (Figure 2). However during the operation we did not find the thrombus formation in the femoral artery. The patient's left lower-extremity perfusion improved, and the distal pulses returned after the procedure. Post-operative treatment for spinal cord injuries and ischemia-reperfusion injuries included that increasing the blood pressure >140 mmHg, intravenous methylprednisolone 1 gram/day for 3 days, and maintaining the cerebrospinal fluid pressure <10 cm H 2 O. On postoperative day one, continuous hemodiafilteration was started because of acute renal failure (ARF) and reduced urinary output. On postoperative day three, ischaemic symptoms including paraplegia totally disappeared. The patient's renal function was rescued from dialysis 1 month later and he was discharged from the hospital on postoperative day 44. Postoperative 3-D reconstruction of the CT-scan revealed the vascular prosthesis of the ascending aorta, the 4-branch prosthetic graft, the stent graft in the descending aorta and the aortofemoral graft were all patent and no thromboemboli were identified (Figure 3).