An unusual complication of lumbar subarachnoid drainage catheter placement in a patient undergoing endovascular stent repair of a thoracic aortic aneurysm.

摘要

AN 86-YEAR-OLD man with a past medical history of hypertension, hyperlipidemia, type II diabetes mellitus, and peripheral vascular disease presented to the authors' institution for an endovascular stent repair of a 6.3 X 6.8 cm thoracic aortic aneurysm extending from the proximal descending thoracic aorta distal to the left subclavian artery to the proximal abdominal aorta immediately superior to the celiac artery. Placement of a multiport lumbar subarachnoid catheter (1.5-mm external diameter; Integra Neuroscience, Plainsboro, NJ) for drainage of cerebrospinal fluid (CSF) was attempted before induction of anesthesia for the peri-operative treatment of potential compromise of spinal cord perfusion and resulting paraplegia. The patient was placed in the right lateral decubitus position with hip flexion, and, under sterile conditions, a 14-G Tuohy needle was easily inserted into the subarachnoid space between the third and fourth lumbar vertebrae through a midline approach using 1% lidocaine local anesthesia. Free flow of CSF was observed, but the catheter could not be advanced into the intrathecal space. The Tuohy needle was repositioned several times with preservation of CSF flow, but further efforts to place the catheter were also unsuccessful. The procedure was abandoned, and the catheter and Tuohy needle were removed with some resistance. The patient reported no new neurologic symptoms as a result of the procedure, and he was transported to the intervention al radiology suite where an endovascular stent was successfully deployed within the thoracic aneurysm through the right femoral artery. After emergence from anesthesia, a computed tomography (CT) scan without contrast was performed (Fig 1).