**Question:** After doing a graft repair of a thoracoabdominal aneurysm, the patient developed weakness in both legs. Most probable cause for this is:

A. Spinal cord injury due to surgical manipulation
B. Post-operative infection
C. Post-operative aneurysm rupture
D. Post-operative pulmonary embolism

**Core Concept:** Thoracoabdominal aortic aneurysm (TAAA) is a dilatation of the thoracic and/or abdominal aorta. Graft repair is a procedure to replace the affected section of the aorta with a synthetic graft. Post-operative complications can occur due to various reasons.

**Why the Correct Answer is Right:** The correct answer is A (Spinal cord injury due to surgical manipulation). During TAAA repair, the spinal cord can be injured secondary to surgical manipulation and manipulation of the surrounding tissues, leading to spinal cord ischemia and/or ischemia of the lower extremities. The surgical procedure itself can cause stretching, compression, or tethering of the spinal cord, leading to neurological deficits.

**Why Each Wrong Option is Incorrect:**

B (Post-operative infection) is incorrect because the patient's weakness is more likely due to the surgical insult rather than infection.

C (Post-operative aneurysm rupture) is incorrect because the patient's weakness is more consistent with spinal cord injury than aneurysm rupture, which would cause back pain, not limb weakness.

D (Post-operative pulmonary embolism) is incorrect because pulmonary embolism would present with respiratory symptoms, not limb weakness. Pulmonary embolism is less likely to cause neurological deficits than spinal cord injury.

**Clinical Pearl:** Thoracoabdominal aortic aneurysm repair is associated with a high risk of spinal cord injury due to the proximity of the spinal cord to the surgical site and the need to manipulate surrounding tissues. Identifying and managing spinal cord injury after TAAA repair is crucial to prevent long-term neurological deficits.

**Correct Answer:** A (Spinal cord injury due to surgical manipulation)

---

**Core Concept:** Post-operative complications following thoracoabdominal aortic aneurysm repair include spinal cord injury due to surgical manipulation and ischemia of the lower extremities.

**Why the Correct Answer is Right:** The correct answer is A (Spinal cord injury due to surgical manipulation). During TAAA repair, the spinal cord is located in close proximity to the surgical site, which increases the risk of spinal cord injury due to surgical manipulation and ischemia of the lower extremities. The surgical procedure itself can cause stretching, compression, or tethering of the spinal cord, leading to neurological deficits.

**Why Each Wrong Option is Incorrect:**

B (Post-operative infection) is incorrect because limb weakness is more likely due to spinal cord injury than aneurysm rupture. Post-operative aneurysm rupture would cause back pain, not limb weakness. Post-operative pulmonary embolism is less likely to cause neurological deficits compared to spinal cord injury.

**Clinical Pearl:** Thoracoabdominal aortic aneurysm repair is associated with