A Case Report of Thoracic Endovascular Aneurysm Repair under Local Anesthesia with Resolution of Acute Onset Lower Extremity Paraplegia from an Acute Complicated Type B Aortic Dissection

Selma El Hag; Susan Shafii; Elizabeth Hartman; Andrew Grande; Michael S Rosenberg; Ramachandra Tummala; Gabriel Loor; Rumi Faizer

doi:10.1016/j.avsg.2020.04.031

A Case Report of Thoracic Endovascular Aneurysm Repair under Local Anesthesia with Resolution of Acute Onset Lower Extremity Paraplegia from an Acute Complicated Type B Aortic Dissection

Ann Vasc Surg. 2020 Oct:68:570.e1-570.e4. doi: 10.1016/j.avsg.2020.04.031. Epub 2020 Apr 25.

Authors

Selma El Hag¹, Susan Shafii², Elizabeth Hartman², Andrew Grande³, Michael S Rosenberg⁴, Ramachandra Tummala³, Gabriel Loor⁵, Rumi Faizer²

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN. Electronic address: elhag005@umn.edu.
² Division of Vascular Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN.
³ Department of Neurosurgery, University of Minnesota, Minneapolis, MN.
⁴ Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN.
⁵ Department of Cardiovascular Surgery, University of Minnesota, Minneapolis, MN.

PMID: 32339676
DOI: 10.1016/j.avsg.2020.04.031

Abstract

Spinal cord ischemia (SCI) is a rare presenting symptom of acute complicated type B aortic dissection, occurring in approximately 3% of patients . We present a case report of a patient with this presentation who had observed resolution of his paraplegia symptoms immediately after placement of a thoracic stent graft under local anesthesia. The temporal association between true lumen flow restoration and paraplegia resolution intraoperatively is a novel finding. We feel that this case report may provide support for recognized cord perfusion theory , as well as contribute to the understanding of the time frame associated with SCI and reversibility of paraplegia.

Publication types

Case Reports

MeSH terms

Acute Disease
Aged
Anesthesia, Local*
Aortic Aneurysm, Thoracic / complications
Aortic Aneurysm, Thoracic / diagnostic imaging
Aortic Aneurysm, Thoracic / surgery*
Aortic Dissection / complications
Aortic Dissection / diagnostic imaging
Aortic Dissection / surgery*
Blood Vessel Prosthesis Implantation*
Endovascular Procedures* / adverse effects
Humans
Lower Extremity / innervation*
Male
Paraplegia / diagnosis
Paraplegia / etiology*
Paraplegia / physiopathology
Recovery of Function
Spinal Cord Ischemia / diagnosis
Spinal Cord Ischemia / etiology*
Spinal Cord Ischemia / physiopathology
Treatment Outcome