Spinal cord ischemia after abdominal aortic operation: is it preventable?

Area of Science:

• Vascular Surgery
• Neurology
• Anesthesiology

Background:

• Spinal cord ischemia (SCI) is a rare but devastating complication following abdominal aortic surgery.
• The exact causes of SCI after these procedures are not fully understood, but are thought to relate to variations in spinal cord blood supply.

Purpose of the Study:

• To investigate the potential causes of spinal cord ischemia in patients undergoing abdominal aortic operations.
• To identify risk factors and contributing elements to this adverse event.

Main Methods:

• A retrospective survey of 18 patients who experienced spinal cord ischemia (paraplegia or paraparesis) after abdominal aortic surgery.
• Review of preoperative imaging (CT, MRI, aortography) and intraoperative data, including aortic cross-clamp details and pelvic artery perfusion techniques.

Main Results:

• Preoperative imaging did not visualize the greater radicular artery (Adamkiewicz's artery) in any of the affected patients.
• Common surgical factors like aortic cross-clamp time, hypotension, and internal iliac artery flow preservation techniques did not consistently correlate with SCI.
• No significant improvement was observed in patients who underwent lumbar drainage after SCI was suspected.

Conclusions:

• Established causes like prolonged aortic cross-clamping, hypotension, embolization, and internal iliac artery interruption were not identified as sole significant factors in this series.
• Performing aortic operations with end-to-end proximal anastomosis in patients with severe iliac artery disease may increase SCI risk, even with attempts to maintain internal iliac perfusion.
• Spinal cord ischemia following abdominal aortic surgery appears to be a largely unpredictable and potentially unpreventable event.