CASE REPORT  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2020 October;61(5):632-8

DOI: 10.23736/S0021-9509.20.11360-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Quadriplegia and quadriparesis after endovascular aortic procedures: a catastrophic and under-reported complication?

Andrea KAHLBERG ¹, Emanuel R. TENORIO ², Alessandro GRANDI ¹ ✉, Gustavo S. ODERICH ², Fabio VERZINI ³, Enrico CIERI ⁴, Luigi BACCANI ⁴, Germano MELISSANO ¹, Roberto CHIESA ¹

¹ Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ² Division of Vascular and Endovascular Surgery, Mayo Clinic Organization, Rochester, MN, USA; ³ Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy; ⁴ Unit of Vascular and Endovascular Surgery, Santa Maria Misericordia Hospital, University of Perugia, Perugia, Italy

In this study are presented three cases of spinal cord ischemia (SCI) involving the cervical-dorsal level and leading to quadriplegia and quadriparesis, following thoraco-abdominal 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.

KEY WORDS: Aortic aneurysm; Angioplasty; Spinal cord ischemia; Quadriplegia