Division of Vascular Surgery, The DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami Jackson Memorial Medical Center, Miami, Fla, USA.
J Vasc Surg. 2010 Mar;51(3):725-8. doi: 10.1016/j.jvs.2009.09.023.
Spinal cord ischemia is a rare complication after abdominal aortic surgery and has been attributed to surgical devascularization of the spinal cord, atheroembolization of the cord circulation, or hypoperfusion of cord structures secondary to hypotension or cord edema. We present a diabetic, hypertensive 75-year-old male with endstage renal disease who presented with a 5.5 cm asymptomatic infrarenal abdominal aortic aneurysm, and concomitant 3.5 cm right common iliac artery aneurysm. After undergoing successful endovascular repair with an aorto-uni-iliac device, unilateral hypogastric artery embolization, and femoral-femoral bypass, he was discharged to a rehabilitation facility neurologically intact with a stage 2 decubitus ulcer. He returned on postoperative day 21 with a large stage 4 septic decubitus ulcer, fever, leukocytosis, hypotension, and paraplegia. We hypothesize that the compromised blood flow from the initial reconstruction, combined with the delayed hypotension imposed by sepsis, resulted in spinal cord infarction. He was eventually discharged to a nursing facility with no improvement in his neurologic status. We report the first case of significantly delayed permanent paraplegia after endovascular abdominal aortic aneurysmorrhaphy.
脊髓缺血是腹主动脉手术后罕见的并发症，其病因可归咎于脊髓的手术性血供丧失、脊髓循环的粥样栓子栓塞，或低血压或脊髓水肿引起的脊髓结构低灌注。我们报告了一例患有终末期肾病的糖尿病、高血压 75 岁男性，其患有 5.5 厘米无症状的肾下型腹主动脉瘤，同时还患有 3.5 厘米右侧髂总动脉瘤。在成功进行了腹主动脉-单-髂动脉装置的血管内修复、单侧髂内动脉栓塞和股-股旁路手术后，他在神经功能完整的情况下出院至康复机构，伴有 2 期压疮。他在术后第 21 天因大的 4 期脓毒性压疮、发热、白细胞增多、低血压和截瘫返回医院。我们推测最初重建的血流受损，加上脓毒症引起的延迟性低血压，导致脊髓梗死。他最终出院至疗养院，神经功能无任何改善。我们报告首例血管内腹主动脉瘤修复术后明显延迟的永久性截瘫病例。
