Ischemic transverse myelopathy after endovascular repair of a thoracic aortic aneurysm

Purpose: To report a dramatic complication after endovascular repair of a d escending thoracic aortic aneurysm (TAA) and to present a classification sy stem and possible methods to avoid spinal cord ischemia. Case Report. A 48-year-old man with a descending TAA between T5 and T9 was treated with endovascular stent-grafts. Fourteen hours after the operation, the patient developed partial transverse myelopathy at level T10. During e mergency conversion to open surgery and implantation of a conventional tube graft, 3 intercostal arteries that had been covered by the stent-graft wer e revascularized. Postoperatively, the neurological deficit improved, and t he patient was able to walk again. Methods to predict and possibly prevent the induction of spinal cord ischemia after endovascular repair of TAA are suggested. Conclusions: Endovascular repair of TAA may induce spinal cord ischemia; pr e- and intraoperative assessment of involved intercostal arteries should be performed.