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

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  • Nomura Ryuya
    Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • Furukawa Kojiro
    Cardiovascular Surgery, Faculty of Medicine, University of Ryukyus
  • Fukuda Tomofumi
    Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • Hirata Yuichiro
    Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • Onzuka Tatsushi
    Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • Tayama Eiki
    Department of Surgery, Kurume University
  • Morita Shigeki
    Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center

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  • 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

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Abstract

<p>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.</p>

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