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Neurologic complications of reoperative and emergent abdominal aortic reconstruction. Ann Vasc Surg 1995 Jan;9(1):95-101

Date

01/01/1995

Pubmed ID

7703069

DOI

10.1007/BF02015322

Scopus ID

2-s2.0-0028960344   19 Citations

Abstract

Patients undergoing emergent and reoperative abdominal aortic reconstructions are at increased risk for ischemic neurologic complications. Between 1986 and 1992 five patients sustained ischemic injuries to the spinal cord, nerve roots, or lumbosacral plexus. Four patients underwent reoperative aortic procedures including removal of an infected aortobifemoral graft and extra-anatomic bypass (n = 3) and aortofemoral graft revision for primary graft failure (n = 1). A fifth patient had a ruptured common iliac aneurysm repaired with an aortobifemoral graft. Three patients undergoing reoperative aortic procedures developed lower extremity paraparesis, patchy sensory deficits, and bowel and bladder dysfunction. Physical examination and electromyography localized the injury to the level of the cauda equina or lumbosacral plexus. The other patient in this group developed incomplete T12 paraplegia. Surgical reconstruction resulted in internal iliac exclusion in all four patients. The incidence of neurologic deficits during this study period was 18% (3/17) in patients requiring aortofemoral graft excision for infection. The patient undergoing aneurysm repair was noted to have paraplegia after surgery and died on the fourth postoperative day. Autopsy revealed evidence of multiple emboli to the kidneys, bowel, and spinal cord. Neurologic deficits after reoperative and emergent abdominal aortic reconstructions are uncommon but devastating complications. Of particular concern is the incidence of neurologic deficits after removal of aortofemoral grafts with disruption of collateral flow to the spinal cord and nerve roots. Consideration should be given to maintaining retrograde perfusion of at least one internal iliac artery via common femoral artery reconstruction in these patients.

Author List

Plecha EJ, Seabrook GR, Freischlag JA, Towne JB

Author

Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Aorta, Abdominal
Aortic Aneurysm, Abdominal
Emergencies
Female
Humans
Ischemia
Lumbosacral Plexus
Male
Middle Aged
Paraplegia
Postoperative Complications
Reoperation
Spinal Cord
Spinal Nerve Roots
jenkins-FCD Prod-398 336d56a365602aa89dcc112f077233607d6a5abc