U Alpagut1, E Dayioglu. 1. Department of Cardiovascular Surgery, Istanbul Medical Faculty of Istanbul University, Istanbul, Turkey.
Abstract
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.
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.