Hypogastric Artery Stenting for Chronic Intermittent Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

TY - JOUR

T1 - Hypogastric Artery Stenting for Chronic Intermittent Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

AU - Gronert, Catharina

AU - Tsilimparis, Nikolaos

AU - Panuccio, Giuseppe

AU - Eleshra, Ahmed

AU - Rohlffs, Fiona

AU - Kölbel, Tilo

PY - 2020/10/1

Y1 - 2020/10/1

N2 - PURPOSE: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting.CASE REPORT: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA.CONCLUSION: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.

AB - PURPOSE: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting.CASE REPORT: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA.CONCLUSION: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.

KW - Aged

KW - Aortic Aneurysm, Thoracic/diagnostic imaging

KW - Aortic Rupture/diagnostic imaging

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Chronic Disease

KW - Endovascular Procedures/adverse effects

KW - Humans

KW - Male

KW - Regional Blood Flow

KW - Spinal Cord/blood supply

KW - Spinal Cord Ischemia/diagnostic imaging

KW - Stents

KW - Treatment Outcome

KW - Vascular Patency

U2 - 10.1177/1526602820925445

DO - 10.1177/1526602820925445

M3 - SCORING: Journal article

C2 - 32431245

VL - 27

SP - 801

EP - 804

JO - J ENDOVASC THER

JF - J ENDOVASC THER

SN - 1526-6028

IS - 5

ER -