It is generally accepted that the earlier the revascularization,
the better the result. However, there may be an 8-h timeframe
before the results of revascularization are poor
3)
. Furthermore,
revascularization may be followed by acute systemic reactions.
Breakdown products of rhabdomyolysis such as myoglobin,
lactic acid dehydrogenase, creatine phosphokinase, and excessive potassium and newly formed clots in the venous system of
a previously ischemic limb are released into the circulation and
may damage the lungs, myocardium, liver, and kidneys. Moreover, compartment syndrome is common after revascularization
of a limb
15)
. We believe a minor impact, such as jumping to the ground, may have induced a thoracic embolus in our second patient, and the massive aortic occlusion caused simultaneous rupture of the artery of Adamkiewicz, the anterior spinal artery, and
segmental spinal arteries resulting in acute hypoperfusion of the
spinal cord and ischemia. However, we cannot rule out the possibility of the original occlusion below the artery of Adamkiewicz or a thoracic aortic dissection. The patient did not feel pain
in the lower extremities as a result of the subsequent paraplegia,
and because the condition is rare, the clinician, who was an
emergency room specialist, overlooked the possibility of aortic
occlusion. It is critically important that clinicians recognize the
possibility of a vascular event in such cases because delayed diagnosis may contribute to a poorer prognosis.