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. 2019 Jun 25;12(2):233-235.
doi: 10.3400/avd.cr.18-00158.

Left Subclavian Artery Revascularization for Delayed Paralysis after Thoracic Endovascular Aortic Repair

Eisaku Nakamura  1 , Kunihide Nakamura  1 , Koji Furukawa  1 , Hirohito Ishii  1 , Yukie Shirasaki  1 , Nobuhiko Ichiki  1 , Kazuhiro Higuchi  1 , Daichi Sakurahara  1 , Tomoka Hamahiro  1
Affiliations

Left Subclavian Artery Revascularization for Delayed Paralysis after Thoracic Endovascular Aortic Repair

Eisaku Nakamura et al. Ann Vasc Dis. .

Abstract

Spinal cord ischemia (SCI) is a devastating complication following thoracic endovascular aortic repair (TEVAR). A man with a ruptured thoracic aortic aneurysm (TAA) was transferred to our hospital. Emergency TEVAR, with left subclavian artery (LSA) coverage, was performed for the ruptured TAA. On postoperative day two, the patient had incomplete paralysis in his legs, presumably caused by SCI. We performed LSA revascularization (LSAR) to provide blood supply to the spinal cord; his paralysis improved and almost resolved after surgery. To our knowledge, this is the first report on LSAR's efficacy for delayed paraplegia due to SCI.

Keywords: delayed paralysis; left subclavian artery revascularization; thoracic endovascular aortic repair.

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Conflict of interest statement

Disclosure StatementNone declared.

Figures

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Fig. 1 (A) Chest radiography showing a huge thoracic aortic aneurysm in the upper left lung field. (B) Preoperative, contrast-enhanced computed tomography showing a giant ruptured thoracic aortic aneurysm close to the left subclavian artery.
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Fig. 2 (A) Intraoperative angiography showing a thoracic aortic aneurysm close to the left subclavian artery (LSA). The need for LSA coverage is apparent. (B) The proximal stent was 45 mm in diameter and 200 mm long; the distal stent was 45 mm in diameter and 150 mm long. LSA coverage was required to achieve an adequate proximal seal. Additionally, LSA coil occlusion was performed.
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Fig. 3 (A, B) Postoperative, contrast-enhanced computed tomography showing the stent graft covering the segment from the left subclavian artery to the level of the ninth thoracic vertebra and completely shielding the aneurysm.
See this image and copyright information in PMC

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