A Case Report of Delayed-Onset Lower Spinal Cord Injury after Replacement of the Aortic Arch and the Descending Thoracic Aorta Using a Stented Elephant Trunk
10.4326/jjcvs.33.189
- VernacularTitle:Ｓｔｅｎｔｅｄ ｅｌｅｐｈａｎｔ ｔｒｕｎｋ法を併用した全弓部・近位下行大動脈置換術後歩行障害の１症例
- Author:
Takashi Kunihara
;
Kenji Matsuzaki
;
Norihiko Shiiya
;
Keishu Yasuda
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2004;33(3):189-192
- CountryJapan
- Language:Japanese
-
Abstract:
Higher incidence of spinal cord injury has been reported in total aortic arch replacement using a stented elephant trunk compared with the conventional one, perhaps due to embolism of atheromatous plaque to the spinal cord arteries. We report a case with delayed-onset lower spinal cord injury after replacement of the aortic arch and the descending thoracic aorta using a stented elephant trunk. A 69-year-old man who had a history of abdominal aortic aneurysm repair using a Y-graft and untreated Crawford's type II thoracoabdominal aortic aneurysm underwent replacement of the aortic arch and the descending thoracic aorta using a stented elephant trunk. He developed weakness of the lower extremities 4 days after the operation. Since a preoperative computed tomography demonstrated thrombus and atheroma in the aneurysm, atheromatous plaque that can cause embolization of the spinal cord arteries was suspected to be responsible for spinal cord injury. As this technique is mostly applied to patients with severe atheromatous aortic disease, embolization of the intercostal arteries or other main branches caused by manipulation of a stent graft must be avoided.
