RESUMO
El aneurisma toracoabdominal requiere de un manejo multidisciplinar debido a su complejidad tanto en la técnica quirúrgica como en el tratamiento anestésico. La complicación postoperatoria más temida es la isquemia medular, que se presenta con una clínica e instauración variable, a su vez que su recuperación puede ser parcial o completa. El manejo postoperatorio de la isquemia medular se basa en medidas que aumentan la perfusión medular, principalmente la optimización hemodinámica y el drenaje de líquido cefalorraquídeo (LCR). Presentamos 2 casos de paraplejía tardía, uno tras reparación abierta de aneurisma aórtico toracoabdominal y otro después del tratamiento endovascular de aneurisma de la aorta torácica descendente, con recuperación completa del déficit neurológico tras drenaje de LCR (AU)
Thoracoabdominal aneurysm requires multidisciplinary management due to its complexity both in surgical technique and anesthetic considerations. One of the most feared postoperative complication is spinal cord ischemia. It can be presented as different clinical patterns, and its recovery may be partial or complete. The postoperative management of spinal cord ischemia is mainly based on techniques to increase spinal cord perfusion, above all, hemodynamic stability and cerebrospinal fluid drainage. We present two cases of delayed paraplegia after an open repair of a thoracoabdominal aneurysm and a descending thoracic aortic aneurysm repair using an endovascular stent graft. They both had a complete neurological recovery after cerebrospinal fluid drainage (AU)
Assuntos
Humanos , Masculino , Feminino , Paraplegia/complicações , Paraplegia/diagnóstico , Paraplegia/tratamento farmacológico , Aneurisma/complicações , Aneurisma/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Hemodinâmica , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares , Isquemia/complicações , Isquemia/diagnóstico , Isquemia do Cordão Espinal/complicações , Líquido CefalorraquidianoRESUMO
Thoracoabdominal aneurysm requires multidisciplinary management due to its complexity both in surgical technique and anesthetic considerations. One of the most feared postoperative complication is spinal cord ischemia. It can be presented as different clinical patterns, and its recovery may be partial or complete. The postoperative management of spinal cord ischemia is mainly based on techniques to increase spinal cord perfusion, above all, hemodynamic stability and cerebrospinal fluid drainage. We present two cases of delayed paraplegia after an open repair of a thoracoabdominal aneurysm and a descending thoracic aortic aneurysm repair using an endovascular stent graft. They both had a complete neurological recovery after cerebrospinal fluid drainage.