Spinal cord ischemia following EVAR of a unilateral Iliac artery dissecting aneurysm: a case report

Abstract Purpose Spinal cord ischemia is a rare complication of endovascular repair of abdominal aortic aneurysm (AAA) that is attributed to the variable anatomy of the artery of Adamkiewicz, embolization of the collateral circulation, or hypoperfusion of cord structures secondary to hypotension. Case Report A hypertensive 83-year-old male with chronic obstructive pulmonary disease presented with a 2.3 cm right iliac artery dissecting aneurysm. Paraplegia occurred on the first day after endovascular repair of iliac artery aneurysm. Postoperative magnetic resonance imaging showed multiple foci of spinal cord ischemia involvement from T10 to L1. Neither arterial pressure augmentation nor steroid therapy was effective. We hypothesized that the compromised blood flow from the artery of Adamkiewicz, combined with the transient hypotension and embolism resulted in spinal cord infarction. The patient was eventually transferred to a nursing facility, with no improvement in his neurological status. Conclusion: SCI after EVAR is an extremely rare and unpredictable complication. Physicians should pay more attention to the patients with comorbidities of atherosclerosis, COPD, or peripheral artery occlusive disease.