TY - JOUR
T1 - Quadriplegia and quadriparesis after endovascular aortic procedures
T2 - A catastrophic and under-reported complication?
AU - Kahlberg, Andrea
AU - Tenorio, Emanuel R.
AU - Grandi, Alessandro
AU - Oderich, Gustavo S.
AU - Verzini, Fabio
AU - Cieri, Enrico
AU - Baccani, Luigi
AU - Melissano, Germano
AU - Chiesa, Roberto
N1 - Publisher Copyright:
© 2020 EDIZIONI MINERV AMEDICA
PY - 2020/10
Y1 - 2020/10
N2 - In this study are presented three cases of spinal cord ischemia (SCI) involving the cervical-dorsal level and leading to quadriplegia and quadriparesis, following thoracoabdominal aortic aneurysm (TAAA) endovascular repair. A 79-year-old woman with an extent III TAAA was scheduled for a multi-step fenestrated/branched endovascular aortic repair. Immediately after the first step, consisting of standard proximal thoracic stent-graft implantation, she developed quadriplegia that did not resolve despite all therapeutic actions, and died therefore on postoperative day 32. A 72-year old male with an extent IV TAAA underwent endovascular repair, using a customized fenestrated aortic stent-graft. Five hours after the procedure, he developed an asymmetric quadriparesis, that progressively resolved after spinal fluid drainage and arterial pressure increase, even if signs of SCI were documented at magnetic resonance imaging (MRI). A 79-year old man, referred for a type II TAAA with rapid enlargement, underwent a one-stage endovascular repair, using a customized branched aortic stent-graft. As soon as the procedure was completed, the patient presented inferior limbs paralysis and upper limbs paresis. Although no signs of SCI were documented at MRI, the patient did not recover and died therefore three months after the procedure. Although rare, cervical-dorsal SCI may develop during TAAA endovascular aortic repair. This possibly catastrophic event should be considered in the decisional process of TAAA repair and considered to allow prompt recognition and treatment.
AB - In this study are presented three cases of spinal cord ischemia (SCI) involving the cervical-dorsal level and leading to quadriplegia and quadriparesis, following thoracoabdominal aortic aneurysm (TAAA) endovascular repair. A 79-year-old woman with an extent III TAAA was scheduled for a multi-step fenestrated/branched endovascular aortic repair. Immediately after the first step, consisting of standard proximal thoracic stent-graft implantation, she developed quadriplegia that did not resolve despite all therapeutic actions, and died therefore on postoperative day 32. A 72-year old male with an extent IV TAAA underwent endovascular repair, using a customized fenestrated aortic stent-graft. Five hours after the procedure, he developed an asymmetric quadriparesis, that progressively resolved after spinal fluid drainage and arterial pressure increase, even if signs of SCI were documented at magnetic resonance imaging (MRI). A 79-year old man, referred for a type II TAAA with rapid enlargement, underwent a one-stage endovascular repair, using a customized branched aortic stent-graft. As soon as the procedure was completed, the patient presented inferior limbs paralysis and upper limbs paresis. Although no signs of SCI were documented at MRI, the patient did not recover and died therefore three months after the procedure. Although rare, cervical-dorsal SCI may develop during TAAA endovascular aortic repair. This possibly catastrophic event should be considered in the decisional process of TAAA repair and considered to allow prompt recognition and treatment.
KW - Angioplasty
KW - Aortic aneurysm
KW - Quadriplegia
KW - Spinal cord ischemia
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U2 - 10.23736/S0021-9509.20.11360-0
DO - 10.23736/S0021-9509.20.11360-0
M3 - Article
C2 - 32558527
AN - SCOPUS:85096815495
SN - 0021-9509
VL - 61
SP - 632
EP - 638
JO - Journal of Cardiovascular Surgery
JF - Journal of Cardiovascular Surgery
IS - 5
ER -