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Decision to Interrupt Second-Stage Side-Branch Completion in Thoracoabdominal Branched Aortic Stent Grafting to
Joseph Touma1, Bachir Benamara1, Hicham Kobeiter2
1Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France.
Background:
Spinal cord ischemia (SCI) is a severe complication of extended endovascular repair of thoracoabdominal aneurysms. We describe voluntary interruption of side-branch completion in staged branched endovascular aneurysm treatment due to uncertainty regarding SCI possible onset, based on intraoperative angiography findings.
Methods:
We report a case of a staged endovascular treatment of thoracoabdominal aortic aneurysm in a 64-year-old patient using a branched endograft with an additional side branch that allows temporary sac perfusion to prevent SCI. The third operative step was intended to occlude the side branch. Intraoperative angiography through the side branch demonstrated circulating aneurysm sac, with patent inferior intercostal and superior lumbar arteries giving direct blood supply to a clearly visible anterior spinal artery. The procedure was stopped.
Results:
One month later, sac thrombosis occurred spontaneously and was clinically responsible for neurogenic claudication that resolved during follow-up.
Conclusion:
Interrupting side-branch completion seems to have allowed additional ischemic conditioning of the spinal cord as the spontaneous sac thrombosis induced mild neurological event.