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Case Reports
. 2014 Apr 16:2014:bcr2013202283.
doi: 10.1136/bcr-2013-202283.

Surgical repair following trauma to vascular graft causing spinal cord infarction

Sayinthen Vivekanantham  1 , Gokulan Phoenix, Chetan Khatri, Saroj Das
Affiliations
Case Reports

Surgical repair following trauma to vascular graft causing spinal cord infarction

Sayinthen Vivekanantham et al. BMJ Case Rep. .

Abstract

A 55-year-old woman with a background of vascular disease presented with signs of bilateral limb ischaemia. Following elective axillobifemoral bypass and hospital discharge, accidental axillary trauma causing a chest wall haematoma, the patient underwent an emergency graft repair. Postextubation, she reported with absent sensation in her legs. Spinal cord infarction was diagnosed through clinical assessment and exclusion of other causes. The aetiology of compromise to the spinal cord blood supply is unclear. Possibilities include intraoperative hypotension, inadvertent compromise to blood supply of thoracic radicular arteries, dislodged atherosclerotic emboli or a combination of these factors. Spinal cord infarction recognised early can be treated. Sedation to assist ventilation had obscured the problem early enough to consider treatment. Patients with vascular risk factors should be carefully managed intraoperatively to minimise hypotensive episodes and care should also be taken not to compromise blood flow of radicular arteries.

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Figures

Figure 1
Figure 1
Arterial blood supply to the spinal cord. Reproduced with permission.
Figure 2
Figure 2
Arterial blood supply to the spinal cord in relation to the aorta. Reproduced with permission.
Figure 3
Figure 3
Transverse cross section of the spinal cord showing distribution of the spinal cord tracts. Reproduced with permission.
See this image and copyright information in PMC

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