A Case of Paraplegia Following Elective Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm and Literature Review in Japanese

Abstract

A 78-year-old woman was presented with an 80-mm infrarenal abdominal aortic aneurysm. The inferior mesenteric artery was occluded. The bilateral internal iliac arteries, 5 pairs of the intercostal arteries, and 3 pairs of the lumbar arteries were patent. The Adamkiewicz artery was unidentified. Endovascular aneurysm repair (EVAR) under general anesthesia was performed. The limbs of the stent graft were landed on the bilateral common iliac arteries. Since admission to the intensive care unit, numbness in bilateral lower extremities had continued. Four hours after the operation, thermoanesthesia and analgesia below the L1 level and motor paralysis of the bilateral lower extremities were observed. Steroid pulse therapy, continuous intravenous infusion of naloxone, and cerebrospinal drainage (CSFD) were commenced for paraplegia. These treatments, however, were ineffective. Magnetic resonance imaging (T2WI) revealed swelling and raised signal in the spinal cord from the Th11 to L1 level, and spinal cord infarction was diagnosed. There is no valid prophylaxis for postoperative SCI. Although CSFD might be effective to treat SCI to some extent, explaining the risk of post-EVAR SCI (despite extremely low) is important in obtaining informed consent.