Late neurological recovery of paraplegia after endovascular repair of an infected thoracic aortic aneurysm

Mees BME, Bastos Gonçalves F, Koudstaal PJ, et al (Erasmus Univ Med Ctr, Rotterdam, The Netherlands) J Vasc Surg 57:521-524, 2013^§

Abstract

Spinal cord ischemia is a potentially devastating complication after thoracic endovascular aorta repair (TEVAR). Patients with spinal cord ischemia after TEVAR often develop paraplegia, which is considered irreversible, and have significant increased postoperative morbidity and mortality. We report the case of a patient with unusual late complete neurologic recovery of acute-onset paraplegia after TEVAR for an infected thoracic aortic aneurysm (Fig 2).

Figure 2 Preoperative and postoperative computed tomographic (CT) angiograms showing the position of significant intercostal arteries at the T11-T12 level (arrows) covered by the stent graft. Five of seven pairs (on preoperative CT angiography) of intercostal arteries in the descending aorta were covered, including the large pair shown, which is the largest and located in the classic position of the artery of Adamkiewicz. One pair of lumbar arteries at the visceral aortic segment and four pairs at the infrarenal aorta were not covered and remained patent. The left subclavian and vertebral artery, the inferior mesenteric artery, and both hypogastric arteries with numerous collaterals all were patent. (Reprinted from the Journal of Vascular Surgery. Mees BME, Bastos Gonçalves F, Koudstaal PJ, et al. Late neurological recovery of paraplegia after endovascular repair of an infected thoracic aortic aneurysm. J Vasc Surg. 2013;57:521-524, Copyright 2013, with permission from the Society for Vascular Surgery.)

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