Spinal cord ischemia after abdominal aortic procedures: is previous colectomy a risk factor?

Pelvic ischemia is a potential cause of spinal cord infarction after abdominal aortic surgery. Although postoperative cord ischemia is often unpredictable, certain patient subgroups may be at greater risk and identified as such before surgery. The case of a 64-year-old man who became paraplegic after an infrarenal aortoiliac aneurysm repair is reported. He had lost his mesenteric arcade as a result of a prior colectomy. Aortoiliac reconstruction required the interruption of antegrade hypogastric blood flow. Restoring circulation to at least one hypogastric artery is a tenet of modern aortic surgery. However, the loss of both internal iliac arteries and the occlusion of the inferior mesenteric artery at its origin are occasionally well tolerated because of a mesenteric collateral pathway. Colectomy eliminates the mesenteric arcade and further increases the risk of spinal ischemia when attempts at pelvic revascularization have failed.