• Kentaro Akabane, Tetsuro Uchida, Rieko Umetsu, Shuto Hirooka, Cholus Kim, Hideaki Uchino, and Takao Shimanuki.
• Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata, Japan.
• Medicine (Baltimore). 2021 Oct 29; 100 (43): e27619e27619.

IntroductionIsolated internal iliac artery (IIA) aneurysms (IIIAAs) rarely occur. However, they may enlarge asymptomatically and rupture, causing fatality. Even after successful surgery of ruptured IIIAAs, there might be a potential risk of postoperative spinal cord ischemia (SCI)-related paraplegia, which is extremely rare. However, this paraplegia significantly impacts patients' activities of daily living.Patient ConcernsA 71-year-old man who had no remarkable medical history was referred to our hospital with sudden lower abdominal pain.DiagnosisComputed tomography (CT) revealed right IIIAA with small volumes of contrast medium extravasation and hematoma. He presented with cyanosis in the bilateral lower limbs. Moreover, blood gas analysis showed lactic acidosis. Therefore, he was diagnosed with ruptured IIIAA complicated by peripheral circulatory failure.InterventionsConsidering his pre-shock status, an emergency operation comprising ligation of the proximal neck and suture closure of the distal IIA orifice was successfully performed.OutcomesImmediately after surgery, motor and sensory dysfunction in the bilateral lower limbs occurred. Magnetic resonance imaging confirmed the presence of SCI. The patient could not stand independently and had neurogenic bladder and rectal disorder.ConclusionPostoperative SCI is a serious complication with no definitive predictors, preventive methods, or highly efficacious treatments. Therefore, vascular surgeons should preempt its occurrence and focus on preventing hemodynamic instability and maintain collateral extra-segmental arterial blood flow, especially in ruptured cases.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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