Evaluation of possible sources of polymer embolization after fenestrated aortic repairs mimicking spinal cord ischemia

Hydrophilic polymer embolization (HPE) syndrome after fenestrated endovascular aortic repair is a rare and devastating complication. Currently, no data exist linking clinical HPE to specific candidate endovascular devices from which the polymer may have arisen. We report two cases of HPE in patients who underwent fenestrated endovascular aortic repairs. Using a dermal biopsy sample and 18 routinely used devices, scanning electron microscopy and energy dispersive x-ray spectroscopy established matches in elemental signature between the devices and embolized material located in dermal capillaries. Using a carbon to oxygen ratio of approximately 1.5, we identified eight devices with polymer material suspected to be the source of the embolization.