A Case Report of Delayed-Onset Lower Spinal Cord Injury after Replacement of the Aortic Arch and the Descending Thoracic Aorta Using a Stented Elephant Trunk

(Department of Cardiovascular Surgery, Hokkaido University, Sapporo, Japan)

Takashi Kunihara Kenji Matsuzaki Norihiko Shiiya
Keishu Yasuda
Higher incidence of spinal cord injury has been reported in total aortic arch replacement using a stented elephant trunk compared with the conventional one, perhaps due to embolism of atheromatous plaque to the spinal cord arteries. We report a case with delayed-onset lower spinal cord injury after replacement of the aortic arch and the descending thoracic aorta using a stented elephant trunk. A 69-year-old man who had a history of abdominal aortic aneurysm repair using a Y-graft and untreated Crawfordfs type II thoracoabdominal aortic aneurysm underwent replacement of the aortic arch and the descending thoracic aorta using a stented elephant trunk. He developed weakness of the lower extremities 4 days after the operation. Since a preoperative computed tomography demonstrated thrombus and atheroma in the aneurysm, atheromatous plaque that can cause embolization of the spinal cord arteries was suspected to be responsible for spinal cord injury. As this technique is mostly applied to patients with severe atheromatous aortic disease, embolization of the intercostal arteries or other main branches caused by manipulation of a stent graft must be avoided.
@Jpn. J. Cardiovasc. Surg. 33: 189-192 (2004)