Neurological Deficit Secondary to Spinal Cord Ischaemia after Infrarenal Abdominal Aortic Repair for Aorto-Iliac Occlusive Disease: A Case Report

Preoperative subtraction magnetic resonance (MR) angiography providing a right-anterior overview on the abdominal aorta and left and right iliac system. The 80% stenosis of the infrarenal abdominal aorta is depicted by an asterix. Furthermore, the left common, internal and external iliac arteries were occluded (arrowheads). This occlusion continued as far as the inguinal ligament. The right common iliac artery showed an 80% stenosis, the right external iliac artery was narrowed and the right internal iliac artery (IIA) was fragile, but patent (white arrow). The profundal and superficial femoral arteries showed adequate filling on both sides. Additionally, the middle sacral artery contributed to the femoral arteries by collateral flow.

Dedicated contrast-enhanced magnetic resonance angiography conducted 4 months after the onset of the partial anterior spinal artery syndrome. (a) Sagittal view providing an overview in which the prosthetic abdominal aorta (asterisk) is depicted. The patent right internal iliac artery (of which a segment is marked by an oblique white arrow) contributed to the segmental arteries (double arrowheads), which were bypassed by the prosthesis, by collateral circulation. Note that the segmental supplier (SA) of the Adamkiewicz artery (AKA) was located at vertebral level T10 and was well above the level of the prosthesis. (b) The direct segmental supply from the aorta to the anterior spinal artery (ASA) was not interrupted postoperatively, as shown in the curved multiplanar reformation.