A Case of Paraplegia after Total Arch Replacement with Frozen Elephant Trunk for Acute Type A Aortic Dissection

Ryuya Nomura; Kojiro Furukawa; Tomofumi Fukuda; Yuichiro Hirata; Tatsushi Onzuka; Eiki Tayama; Shigeki Morita

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A Case of Paraplegia after Total Arch Replacement with Frozen Elephant Trunk for Acute Type A Aortic Dissection

VernacularTitle:術後に対麻痺を発症した Stanford A 型急性大動脈解離に対するオープンステントグラフト併用全弓部置換術の1例
Author: Ryuya NOMURA ¹ ; Kojiro FURUKAWA ² ; Tomofumi FUKUDA ¹ ; Yuichiro HIRATA ¹ ; Tatsushi ONZUKA ¹ ; Eiki TAYAMA ³ ; Shigeki MORITA ¹
Author Information

1. Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
2. Cardiovascular Surgery, Faculty of Medicine, University of Ryukyus
3. Department of Surgery, Kurume University
Keywords: acute type A aortic dissection; frozen elephant trunk (open stent graft); paraplegia
From:Japanese Journal of Cardiovascular Surgery 2022;51(1):35-38
CountryJapan
Language:Japanese
Abstract: The frozen elephant trunk technique (FET) for the treatment of acute aortic dissection is associated with more favorable remodeling in the descending aorta compared to those patients without FET, but it may also be associated with postoperative spinal cord injury (SCI) and actually,some postoperative SCI cases after FET are reported. Several risk factors for SCI are known and one of them is due to the occlusion of intercostal arteries from false lumen. A 71-year-old woman underwent total arch replacement with FET, but after surgery, she noticed decreased movement in both lower extremities and was suspected of postoperative paraplegia. She went through cerebrospinal fluid drainage but didn't get better at all. According to the preoperative contrast computed tomography images, seven out of ten intercostal arteries were originating from the false lumen and six of them were occluded after surgery. When most of intercostal arteries are originating from the false lumen and there is no entry inside the descending and abdominal aorta, the intercostal arteries may be occluded due to thrombosis of the false lumen and it may cause spinal cord ischemia after surgery.