Touma Joseph, Benamara Bachir, Kobeiter Hicham, Desgranges Pascal
Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France.
Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France.
Ann Vasc Surg. 2017 Jul;42:303.e1-303.e4. doi: 10.1016/j.avsg.2017.01.013. Epub 2017 Apr 4.
Spinal cord ischemia (SCI) is a severe complication of extended endovascular repair of thoracoabdominal aneurysms. We describe voluntary interruption of side-branch completion in staged branched endovascular aneurysm treatment due to uncertainty regarding SCI possible onset, based on intraoperative angiography findings.
We report a case of a staged endovascular treatment of thoracoabdominal aortic aneurysm in a 64-year-old patient using a branched endograft with an additional side branch that allows temporary sac perfusion to prevent SCI. The third operative step was intended to occlude the side branch. Intraoperative angiography through the side branch demonstrated circulating aneurysm sac, with patent inferior intercostal and superior lumbar arteries giving direct blood supply to a clearly visible anterior spinal artery. The procedure was stopped.
One month later, sac thrombosis occurred spontaneously and was clinically responsible for neurogenic claudication that resolved during follow-up.
Interrupting side-branch completion seems to have allowed additional ischemic conditioning of the spinal cord as the spontaneous sac thrombosis induced mild neurological event.
脊髓缺血（SCI）是胸腹主动脉瘤血管内修复术的严重并发症。基于术中血管造影结果，由于对SCI可能发生的不确定性，我们描述了在分期分支血管内动脉瘤治疗中自愿中断侧支完成情况。
我们报告了一例64岁患者胸腹主动脉瘤的分期血管内治疗病例，使用带有额外侧支的分支型人工血管，该侧支允许临时向瘤腔灌注以预防SCI。第三步手术旨在闭塞侧支。通过侧支进行的术中血管造影显示瘤腔有血流，肋间下动脉和腰动脉上段通畅，直接向清晰可见的脊髓前动脉供血。手术停止。
1个月后，瘤腔自发形成血栓，临床上导致神经源性间歇性跛行，在随访期间症状缓解。
中断侧支完成似乎使脊髓得到了额外的缺血预处理，因为自发的瘤腔血栓形成引发了轻度神经事件。
