Objectives: to evaluate the prevalence and the possible causes of spinal cord ischaemia (SCI) following endovascular abdominal aneurysm repair (EVAR). Differences in the incidence of this complication between endovascular treatment and published series following conventional treatment were assessed.
Design: analysis of patients enrolled in the EUROSTAR collaborators registry.
Materials and methods: 2862 patients operated between July 1994 and July 2000 were analysed. Patient characteristics, aneurysm morphology, procedure characteristics and potential causative factors with particular interference with pelvic circulation or pelvic embolisation were related to the risk of SCI.
Results: six patients (0.21%) were identified with postoperative symptoms of SCI: one complete spinal cord infarction (type I), two anterior spinal artery syndromes (type II) and three combinations of root lesions and centromedullary infarcts (type III). In the patients with type I or II lesions (3/6) no regression of neurological symptoms was noted, whereas the patients with type III lesions (3/6) had partial regression of symptoms in two cases and a full neurological recovery in one case. There was a significant correlation between emboli (p < 0.001) and coil embolisation of hypogastric or lumbar arteries (p < 0.029) and the development of SCI.
Conclusions: SCI is equally rare following open aortic surgery or EVAR. Microembolism is the probable cause. SCI should be mentioned when taking informed consent.
Copyright 2001 Harcourt Publishers Limited.