ORIGINAL ARTICLES  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2002 December;43(6):865-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Anterior spinal artery syndrome after infrarenal abdominal aortic surgery

Alpagut U., Dayioglu E.

Department of Cardiovascular Surgery Istanbul Medical Faculty of Istanbul University Istanbul, Turkey

Back­ground. Neu­ro­log­ical com­pli­ca­tions ­such as par­a­plegia or par­a­par­esis due to ­spinal ­cord ­ischemia has ­been an unpre­dict­able, dev­as­tating ­event ­after infra­renal abdom­inal ­aortic sur­gery. The aim of our ­study is to ­focus the impor­tance of ­this ­entity and in ­this con­nec­tion to ­review the vas­cular ­anatomy of the ­spinal ­cord, inci­dence and eti­ology of ­spinal ­cord ­ischemia, ­methods of pre­ven­tion, and man­age­ment of the ­patient.
­Methods. ­Eight ­patients ­were iden­ti­fied ­with ­spinal ­cord ­ischemia man­i­fested by par­a­plegia or par­a­par­esis ­after 1331 abdom­inal ­aortic oper­a­tions. All the ­patients who had ­spinal ­cord ­ischemia were exam­ined for ­risk fac­tors.
­Results. ­Three ante­rior ­spinal ­artery syn­drome neu­ro­log­ical ­recovery ­occurred but 5 of ­them ­remained ­unchanged. Two ­patients ­died ­within 30 ­days of oper­a­tion.
Con­clu­sions. Com­plete par­a­plegia due to ­ischemic ­spinal ­cord ­injury was ­thought to be ­caused by inter­rup­tion of crit­ical col­lat­eral ­blood ­supply to the ­spinal ­cord. For ­this ­reason avoid­ance of pro­longed ­aortic ­cross ­clamp ­time, hypo­ten­sion, and its asso­ciated low ­flow to the ­spinal ­cord, ­paying atten­tion to pre­vent ath­e­rom­a­tous embol­iza­tion of Adam­kie­wicz ­artery and ­pelvic cir­cu­la­tion can pre­vent ­this com­pli­ca­tion. If the ­greater medul­lary ­artery is anom­a­lously low ­from the ana­tomic local­iza­tion the ­blood ­supply of the ­cord may be inad­e­quate, so ­this com­pli­ca­tion cannot be ­avoided.