Lioupis Christos, Tyrrell Mark, Valenti Domenico
Department of Vascular Surgery, King's College Hospital, London, United Kingdom.
Vasc Endovascular Surg. 2010 Jan;44(1):56-60. doi: 10.1177/1538574409345031. Epub 2009 Nov 16.
We report a case of paraplegia occurring after an elective endovascular aneurysm repair (EVAR) that was reversed by cerebrospinal fluid (CSF) drainage. This case report highlights the reality that the endovascular management of abdominal aortic aneurysms (AAAs) with large volumes of mural thrombus and complex iliac anatomy can be complicated by spinal cord ischemia (SCI). The presumed mechanism of SCI is dissemination of atherosclerotic material during protracted catheter and wire manipulations. Embolization of internal iliac arteries (IIAs), profunda femoral arteries, and possibly other arterial networks may explain the delayed presentation. The complex iliac anatomy necessitating covering of one and reconstruction of the other hypogastric artery and the prolonged operative time may be 2 other contributing factors. The prompt CSF drainage may reverse the neurologic deficit.
我们报告了1例择期血管内动脉瘤修复术（EVAR）后发生截瘫但通过脑脊液（CSF）引流得以逆转的病例。本病例报告凸显了这样一个现实，即对于存在大量附壁血栓且髂部解剖结构复杂的腹主动脉瘤（AAA）进行血管内治疗时，可能会因脊髓缺血（SCI）而变得复杂。推测SCI的机制是在长时间的导管和导丝操作过程中动脉粥样硬化物质的播散。髂内动脉（IIA）、股深动脉以及可能的其他动脉网络的栓塞或许可以解释延迟出现的情况。复杂的髂部解剖结构需要覆盖一侧并重建另一侧髂内动脉，以及手术时间延长可能是另外两个促成因素。及时进行脑脊液引流可能会逆转神经功能缺损。
