Ischemia of spinal cord following elective operative procedures of the infrarenal abdominal aorta.

Objective: Ischemia of the spinal cord following procedures of the infrarenal abdominal aorta and the iliac arteries due to aneurysmatic or occlusive disease.

Design: Retrospective study, duration of follow up: two years.

Settings: Vascular Department of the 2nd Surgical Clinic of the University of Athens, Medical School.

Patients: 1,112 operative procedures to the infrarenal abdominal aorta and iliac arteries, carried out from January 1, 1976 to June 30, 1994; 665 cases were aneurysms, electively operated, to which a tube graft was placed in 390 and a bifurcated graft in the remaining 265. Similarly 457 bifurcated prostheses were placed due to stenotic disease.

Interventions: Aneurysmectomy, graft insertion.

Measures: Death, severe disability.

Results: Ischemic damage to the spinal cord was noted in two cases postoperatively. The first case following placement of bifurcated prosthesis due to high occlusion of the abdominal aorta and the second case following resection of an aneurysm and placement of a tube graft. One of the patients passed away on the 43rd postoperative day, and the other 18 months after was able to stand but, however, could not walk easily without the help of another person.

Conclusions: The complication seems to be multicausal, carrying a bad prognosis and cannot be foreseen. The stable hemodynamic condition of the patient during the operative and postoperative period with revascularisation of at least one hypogastric artery, reduces the time of aortic occlusion and securing collateral circulation might reduce these complications. Also preopeorative angiography of the spinal cord with more sophisticated techniques, might constitute the most reliable prognosis in the future.