Clavert P, Chakfé N, Edah-Tally S, Beaufigeau M, Hassani O, Thaveau F, Kahn J L, Kretz J G
Service de chirurgie Cardio-Vasculaire, Les Hopitaux Universitaires de Strasbourg.
J Mal Vasc. 1999 Jun;24(3):229-32.
We report the case of an 84 year-old man who suffered of paraplegia after surgery of an abdominal aortic aneurysm. The neurologic status did not improve during 5 years of follow-up. This complication is rare in light of the review of the literature. It is more frequent after emergency (1.4%) and redux (19%) surgery than after elective surgery (1.1%). Its mechanisms are anatomic (occlusion of the Adamkievitz artery and of the pelvic collateral arteries) and hemodynamic mechanisms (thromboembolism, low systemic tension, long supra-renal clamping). Since pre-operative aortography to detect anatomic variations is not realistic, its only prevention remains maintenance of intra-operative hemodynamic, systemic heparinization, and preservation of the pelvic collateral circulation.
我们报告了一例84岁男性患者，其在腹主动脉瘤手术后出现截瘫。在5年的随访期间，神经功能状态未得到改善。根据文献回顾，这种并发症很罕见。与择期手术（1.1%）相比，急诊手术（1.4%）和再次手术（19%）后更常见。其机制包括解剖学机制（Adamkievitz动脉和盆腔侧支动脉闭塞）和血流动力学机制（血栓栓塞、全身性低血压、长时间肾动脉上阻断）。由于术前进行主动脉造影以检测解剖变异并不现实，其唯一的预防措施仍然是维持术中血流动力学稳定、全身肝素化以及保留盆腔侧支循环。
