Spinal cord ischemia complicating treatment of abdominal aortic aneurysms: a legal overview: A rare complication of abdominal aortic surgery and its legal consequences

Giuseppe  Basile; Marcello Ghezzi; Luigi Federico Rinaldi; Chiara Brioschi; Alberto Passeri; Arianna Giorgetti; Enrico Maria Marone

doi:10.23750/abm.v93iS1.12763

Spinal cord ischemia complicating treatment of abdominal aortic aneurysms: a legal overview

A rare complication of abdominal aortic surgery and its legal consequences

Authors

Giuseppe Basile Trauma Surgery IRCCS Orthopaedic Institute Galeazzi, Via Galezzi 4, 20161 Milan, Italy.
Marcello Ghezzi Physician Specialist in General Surgery, Angiology and Vascular Surgery.
Luigi Federico Rinaldi University of Genoa
Chiara Brioschi Vascular Surgery, Policlinico di Monza, Via Amati 111, 20900 Monza, Italy.
Alberto Passeri Legal Medicine; Via Garibaldi 110, 35043 Monselice (PD) – Italy
Arianna Giorgetti Department of Medical and Surgical Sciences, Section of Legal Medicine, University of Bologna, Via Irnerio, 49, 40126 Bologna, Italy.
Enrico Maria Marone Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia; Director of Vascular Surgery Department, Gruppo Policlinico di Monza, Monza, Italy.

Keywords:

spinal cord ischemia, vascular surgery, abdominal aortic aneurysm, surgical complications, paraplegia

Abstract

Background and aim: Spinal cord ischemia following open or endovascular aneurysm repair of the abdominal aorta is rare but highly disabling complication. The aim of this work is to report on its occurrence and its legal consequences.

Methods: We report a case of spinal cord ischemia complicating an endovascular aortic repair, its management and sequalae, comparing it with the existing literature and we examine its legal consequences resulting in a malpractice lawsuit and the final decision of the judge.

Results: Although the causal relation between SCI and the neurological deficits reported were assessed by the Court, no element of responsibility imputable to the Hospital or the Medical Staff were found, since the defendant had made every effort to prevent it in the preoperatory setting, and to treat it once it established in the post-operative phase.

Conclusions: predictable but unpreventable complications of necessary interventions rule out medical malpractice, as long as the patient is fully informed about the risks and benefits of the treatment, and provided that in the perioperative setting all due measures are taken in order to prevent it and treat it.

References

Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93.

Gloviczki P, Cross SA, Stanson AW, Carmichael SW, Bower TC, Pairolero PC et al. Ischemic Injury to the Spinal Cord or Lumbosacral Plexus after Aortic-Iliac Reconstruction. Am J Surg. 1991;162:131-6.

Rosenthal D. Spinal Cord Ischemia after Abdominal Aortic Operation: is it Preventable? J Vasc Surg, 1999;30:391-7

P. Berg, D. Kaufmann, C.J. van Marrewijk, J. Buth, Spinal Cord Ischaemia After Stent-graft Treatment for Infra-renal Abdominal Aortic Aneurysms. Analysis of the Eurostar Database. Eur J Vasc Endovasc Surg. 2001;22(4):342-347.

Moulakakis KG, Alexiou VG, Karaolanis G, Sfyroeras GS, Theocharopoulos GN, Lazaris AM, et al. Spinal Cord Ischemia following Elective Endovascular Repair of Infrarenal Aortic Aneurysms: A Systematic Review. Ann Vasc Surg. 2018;52:280-291.

Szilagyi DE, A Second Look at the Etiology of Spinal Cord Damage in Surgery of the Abdominal Aorta J Vasc Surg. 1993:17(6):1111-1113.

Yamada N, Okita Y, Minatoya K, Tagusari O, Ando M, Takamiya M, et al. Preoperative Demonstrations of the Adamkievicz Artery by Magnetic Resonance Angiography in Patients with Descending or Thoracoabdominal Aortic Aneurysms. Eur J Cardiothorac Surg. 2000;18(1):104-11.

Kwok PC, Chung TK, Chong LC, Chan SC, Wong WK, Chan MK, et al. Neurologic Injury after Endovascular Stent-Graft and Bilateral Internal Iliac Artery Embolization for Infrarenal Abdominal Aortic Aneurysm. J Vasc Interv Radiol. 2001;12(6):761-3.