Delayed Paraplegia after Complex Repair of Thoracic Aortic Dissection

Spinal cord ischemia (SCI) is a well-known complication of both open and endovascular repair of the thoracoabdominal aorta. Perioperative maneuvers to increase spinal cord perfusion, including permissive hypertension and lumbar drain placement to control spinal pressure, are commonly used to reduce the risk of SCI. Additional perioperative measures to reduce the susceptibility of the spinal cord to ischemic insult include hypothermia, steroids, and naloxone infusion. Most cases manifest immediately or within days of surgery and improve with the aforementioned maneuvers. We describe a rare occurrence of delayed SCI 20 months after thoracic endovascular aortic aneurysm repair.