Ischemic Injury to the Cauda Equina following Operations for a Ruptured Abdominal Aortic Aneurysm
10.4326/jjcvs.20.11
- VernacularTitle:術後,馬尾神経の虚血性損傷を合併した破裂性腹部大動脈瘤症例
- Author:
Masao UEDA
;
Tomoyuki YAMADA
;
Junzo IEMURA
;
Fumitaka ANDO
;
Hiroshi OKA
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
1990;20(1):11-16
- CountryJapan
- Language:Japanese
-
Abstract:
A 61-year-old man underwent an emergency operation for a ruptured infrarenal abdominal aortic aneurysm. Operations included bifurcated graft replacement of the abdominal aorta, oversewing of five lumbar arteries between L3 and L5, and ligation of the occluded inferior mesenteric artery. Because of the severe adhesions and arteriosclerotic changes over the bifurcation of the abdominal aorta and both common iliac arteries, prolonged aortic cross-clamp time was needed. In spite of stable his postoperative general condition, he suffered paresthesia and complete sensory loss on the left lower leg and the right sole. Moreover he was found to have paresis on the left leg and the right thigh. Knee and ankle deep-tendon reflexes were absent on the left. Lasègue's sign was positive bilaterally, which was more brisk on the left. There was no incontinence of urine and feces. EMG showed neurogenic polyphasic potentials on the lower extremities. MRI of the thoracolumbar spine and sacrum showed no evidence responsible for this neurological deficit, but IV-DSA revealed complete occlusion of the left common and internal iliac arteries. Following the active rehabilitation, he was able to walk unaided, but remained to have residual paresthesia on the left lower leg at his discharge. It was concluded that ischemic injuries to the cauda equina resulted in this rare complication, which seemed to be secondary to oversewing of critical lumbar arteries, prolonged aortic cross-clamp time, and the acute occlusion of the left common and internal iliac arteries.
