• Hirokazu Inoue, Akira Sugaya, Yuya Kimura, Yasuyuki Shiraishi, Ryo Sugawara, Atsushi Kimura, and Katsushi Takeshita.
• Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
• Medicine (Baltimore). 2021 Dec 23; 100 (51): e28347e28347.

RationaleAcute aortic occlusion is an uncommon disease with a high morbidity and high mortality. Clinical symptoms typically include acute lower limb pain, acute paralysis, and absent pulses. We report a very rare case of acute aortic occlusion causing complete paralysis of bilateral lower limbs following microendoscopic laminectomy.Patient ConcernsA 64-year-old man with hypertension, hyperlipidemia, diabetes, and atrial fibrillation underwent microendoscopic laminectomy for lumbar spinal stenosis. After the operation, intermittent claudication improved significantly without neurological deficit. However, 7 days later, he developed complete paralysis of the bilateral lower limbs, extreme pain of the bilateral lower limbs, and mottling of the left extremity.DiagnosisAn emergency magnetic resonance imaging examination revealed no epidural hematoma behind the spinal cord, proscribing spinal cord compression. Computed tomography revealed occlusion of the infrarenal abdominal aorta. Blood tests revealed high values of total plasminogen activator inhibitor-1 before surgery.InterventionsThe acute aortic occlusion was verified and underwent thrombectomy and right axillary-bifemoral bypass.OutcomesFollowing the revascularization, the neurological deficit of the lower limbs improved. On follow-up after 1 year, the muscle strength of the bilateral lower limbs had returned to normal.LessonsThis case presentation highlights the necessity of early diagnosis and early revascularization. Moreover, a preoperative high value of plasminogen activator inhibitor-1 may indicate vascular complications including Acute Aortic Occlusion.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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