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

BACKGROUND AND AIM: The aim of this work is to report on the occurrence of spinal cord ischemia following open and endovascular repair of abdominal aortic aneurysms and its legal consequences, exemplified by a dramatic case report and supported by a review of the current literature on the subject. METHODS: we will focus on whether this rare and fearsome complication is predictable or unpredictable, whether it is attributable to specific professional guilt and if and how it can be prevented and treated. RESULTS: Unpredictability of SCI is part of the dramatic consequence of having an AAA, whose natural history yields to rupture and, in most cases, death. Preventive OAR or EVAR represents the only alternative to this course, and all the diagnostic and therapeutic efforts should aim first of all to detect and treat as many AAAs as possible before they rupture. CONCLUSIONS: the correct compilation of the medical record, and in particular of the operating register, assumes a fundamental role even in the case of infrequent adverse events, in order to demonstrate that, despite the implementation of all the precautions codified by the specialist discipline, it was a matter of adverse event which, however foreseeable, was not concretely preventable in the present case, thus including the event in the realm of “complication” unrelated to profiles of professional responsibility. (www.actabiomedica.it)