Department of Vascular Surgery, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
J Cardiothorac Surg. 2020 Oct 17;15(1):320. doi: 10.1186/s13019-020-01358-x.
The etiology of delayed-onset spinal cord injury (SCI) following endovascular repair of thoraco-abdominal aortic aneurysms (TAAA) is still unclear and may be related to multiple factors. Extravascular factors, such as lumbar spinal stenosis (LSS), may play a significant role in the selection of patient at risk of SCI. In this report we describe a case of paraplegia following thoracic endovascular aortic repair (TEVAR) in a patient suffering from severe and symptomatic LSS and undergoing staged endovascular repair of a TAAA.
A 70-year-old man was admitted to our department with an asymptomatic type III TAAA in previous open repair for abdominal aortic aneurysm. The patient complained of buttock and thigh claudication in the absence of defects in the pelvic perfusion; a spinal magnetic resonance angiography (MRA) showed a severe narrowing of the lumbar canal.. After 24 h from first-step procedure (TEVAR) paraplegia was detected. A cerebrospinal fluid (CSF) drainage was then placed with incomplete recovery.
Stenotic damage to the spinal cord is thought to be the result of direct compression of the neural elements and ischemic disruption of arterial and venous structures surrounding the spinal cord. This comorbidity may constitute an additional anatomic risk factor in those patients currently recognized as prognostically associated to the development of SCI.
胸主动脉腹主动脉瘤（TAAA）血管内修复后迟发性脊髓损伤（SCI）的病因尚不清楚，可能与多种因素有关。血管外因素，如腰椎管狭窄症（LSS），可能在选择易发生 SCI 的患者方面发挥重要作用。在本报告中，我们描述了一例患有严重和症状性 LSS 的患者在接受 TAAA 的分期血管内修复后，在胸主动脉腔内修复（TEVAR）后发生截瘫的病例。
一名 70 岁男性因既往开放性腹主动脉瘤修复的无症状 III 型 TAAA 入院。患者主诉臀部和大腿跛行，但无骨盆灌注缺陷；脊髓磁共振血管造影（MRA）显示腰椎管严重狭窄。在第一步手术（TEVAR）后 24 小时，出现截瘫。然后放置了脑脊液（CSF）引流，但不完全恢复。
脊髓狭窄性损伤被认为是脊髓神经受压和脊髓周围动脉和静脉结构缺血性破坏的结果。这种合并症可能构成目前认为与 SCI 发展相关的预后相关患者的另一个解剖风险因素。
