Surgical repair following trauma to vascular graft causing spinal cord infarction

A 55-year-old woman with a background of vascular disease presented with signs of bilateral limb ischaemia. Following elective axillobifemoral bypass and hospital discharge, accidental axillary trauma causing a chest wall haematoma, the patient underwent an emergency graft repair. Postextubation, she reported with absent sensation in her legs. Spinal cord infarction was diagnosed through clinical assessment and exclusion of other causes. The aetiology of compromise to the spinal cord blood supply is unclear. Possibilities include intraoperative hypotension, inadvertent compromise to blood supply of thoracic radicular arteries, dislodged atherosclerotic emboli or a combination of these factors. Spinal cord infarction recognised early can be treated. Sedation to assist ventilation had obscured the problem early enough to consider treatment. Patients with vascular risk factors should be carefully managed intraoperatively to minimise hypotensive episodes and care should also be taken not to compromise blood flow of radicular arteries.