A Case of Horner Syndrome Following Thoracic Endovascular Aortic Repair

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Horner syndrome (HS) results from a disruption along the oculosympathetic pathway that synapses in the ciliospinal center at the C8-T2 spinal levels. Preganglionic fibers synapse in the superior cervical ganglion before postganglionic fibers move to the eyes and face. HS presents with ipsilateral ptosis, miosis, and facial anhidrosis. Vascular pathology, compression due to malignancy, or iatrogenic injury are common causes. HS can follow thoracic endovascular aortic repair (TEVAR) when the proximal thoracic aorta or adjacent branch vessels are involved. Prevalence varies widely likely due to underreporting or misdiagnosis. Differential diagnosis includes stroke with 4.6% of patients experiencing perioperative stroke following TEVAR. Cervical supra-aortic revascularization performed prior to TEVAR cases is also implicated with 1.9% of patients experiencing HS following this procedure.

The patient was a 68-year-old man with a history of type A aortic dissection repair who presented with aneurysmal degeneration of the aortic arch and thoracoabdominal aorta. Pertinent comorbidities included paroxysmal atrial fibrillation, coronary artery disease, heart failure with preserved ejection fraction, hypertension and hyperlipidemia. Notable surgical history included bilateral iliac artery aneurysm repair, inguinal hernia repair, left mastectomy, L4-L5 discectomy, and pelvic trauma repair. The patient was a former smoker and used marijuana twice weekly. The patient initially underwent an aortic arch debranching procedure in which a left sided carotid-subclavian transposition was performed due to the proximal nature of the aneurysmal disease. This allowed proper spacing and adequate healthy vasculature for a thoracic endovascular aortic repair (TEVAR) procedure the next day. TEVAR was performed from just proximal to the stump of the subclavian artery to the diaphragm.

A compressive hematoma or damage to the sympathetic chain itself likely occurred in the aortic debranching procedure, resulting in HS. The patient had high risk for stroke and injury from excessive CSF drainage which would also present with neurologic signs. Accurate diagnosis of HS based on history and careful exam avoided unnecessary workup. HS should be recognized as a potential complication of supra-aortic revascularization and TEVAR.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1971

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