Yamauchi Takashi, Kubota Suguru, Hasegawa Kosei
Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan.
Ann Vasc Dis. 2018 Dec 25;11(4):562-564. doi: 10.3400/avd.cr.18-00090.
We report a rare case of delayed paraplegia triggered by gastrointestinal (GI) bleeding 8 months after thoracic endovascular aortic repair (TEVAR). A 78-year-old male underwent TEVAR of a descending thoracic aortic aneurysm without a postoperative neurological deficit and was discharged. Magnetic resonance image showed spinal cord infarction from Th8 to L1, and enhanced computed tomography showed a patent Adamkiewicz artery. The ostium of the intercostal artery connected with the Adamkiewicz artery was occluded. Patients with a history of TEVAR might be more vulnerable to spinal cord ischemia around the Adamkiewicz artery, which can be triggered by common hemorrhagic diseases, such as GI bleeding, even remote from the procedure.
我们报告了1例罕见的病例，患者在胸主动脉腔内修复术（TEVAR）后8个月因胃肠道（GI）出血引发迟发性截瘫。一名78岁男性接受了降主动脉瘤的TEVAR手术，术后无神经功能缺损并出院。磁共振成像显示胸8至腰1脊髓梗死，增强计算机断层扫描显示Adamkiewicz动脉通畅。与Adamkiewicz动脉相连的肋间动脉开口闭塞。有TEVAR病史的患者可能更容易发生Adamkiewicz动脉周围的脊髓缺血，即使在远离手术的情况下，常见的出血性疾病（如GI出血）也可能引发这种情况。
