A Case of Abdominal Aortic Aneurysm Associated with Postoperative Paraplegia

(Department of Cardiovascular Surgery, Jikei University Kashiwa Hospital, Chiba, Japan and Department of Cardiovascular Surgery, Jikei University School of Medicine*, Tokyo, Japan)

Motohiro Oshiumi Shinichi Ishii Hirokuni Naganuma
Makoto Sumi Kazuhiro Hashimoto*
We present a very rare case of abdominal aortic aneurysm associated with paraplegia. A 68-year-old man developed paraplegia following resection of a infrarenal abdominal aortic aneurysm. The aorta was clamped just below the renal arteries. In this case interruption of the radicular artery magna (RAM; Adamkiewicz artery) might have caused serious ischemia of the spinal cord. Spinal cord ischemia is a very rare and unpredictable complication in surgery of infrarenal abdominal aortic aneurysms because the spinal cord is generally protected from irreversible ischemia during infrarenal aortic occlusion by the presence of the RAM which arises above the renal artery (Even if RAM interruption might arise, the lower renal artery, and other radicular arteries are usually present above the renal arteries). We feel that reducing aortic cross-clamping time as short as possible and avoiding intra- and postoperative hypotensive episodes to keep adequate blood flow of collaterals seem to be the most important factors to prevent spinal cord ischemia.
@Jpn. J. Cardiovasc. Surg. 32: 362 -365(2003)