[Dissection of descending aorta with spinal paralysis]

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• A 56-year-old male with a history of ascending aorta and total arch replacement for Stanford type A aortic dissection developed lower limb diplegia and vesicorectal dysfunction.
• Computed tomography (CT) revealed a large (80 mm) serpentine aneurysm in the descending aorta, extending from the left subclavian artery to the diaphragm.

Observation:

• Magnetic resonance imaging (MRI) was utilized to identify the Adamkiewicz artery, crucial for spinal cord blood supply, but it could not be visualized.
• The patient presented with significant neurological deficits, including paraplegia and bowel/bladder dysfunction, indicative of spinal cord ischemia.

Findings:

• Surgical intervention involved graft replacement of the descending aortic aneurysm.
• Reconstruction of the 8th intercostal artery using a branch graft was performed to potentially restore spinal cord perfusion.
• The patient experienced an uneventful postoperative recovery, with neurological symptoms potentially improving.

Implications:

• This case suggests that graft replacement, including targeted revascularization of spinal arteries like the 8th intercostal artery, can be an effective treatment for spinal cord ischemia secondary to descending aortic aneurysms.
• The successful management highlights the importance of considering complex aortic pathology and its neurological sequelae in surgical planning.
• Further research may explore the long-term efficacy and specific indications for such reconstructive techniques in preventing or treating spinal cord ischemia.