Spinal cord ischemia after infrarenal abdominal aortic aneurysm repair is a rare but catastrophic event. We present a case of paraplegia following elective repair of an infrarenal aortic aneurysm. An 82-year-old man was admitted for elective repair of a 6-cm infrarenal aortic aneurysm involving the left common iliac artery. Left external iliac occlusion was also noted. In a routine operation, the abdominal aorta was cross-clamped below the level of the renal arteries, a Dacron bifurcated graft was anastomosed end-to-end to the infrarenal aorta and end-to-end to the right common iliac artery and the left hypogastric artery. The left external iliac artery was revascularized by the use of an interposed graft between the left limb of the graft and the left common femoral artery. Inferior mesenteric artery was implanted into the body of the Dacron aortic graft as a Carrel patch. The duration of the operative procedure was 266 min, and the aortic cross-clamp time was 40 min. Intraoperative blood loss was 1141 g, and a cell saver was used. On the first postoperative day paraplegia occurred, with intact proprioception and vibration sense. Faecal and urinary incontinence were also noted. He had loss of pain and temperature sensation below the L-2 dermatome (more to the left). Magnetic resonance imaging showed a zone of high-signal intensity (Th11-L2) consistent with edema after spinal cord infraction. The patient was placed under intensive physiotherapy and rehabilitation with minimal improvement, but remained paraplegic at discharge, 6 months after operation. Spinal cord ischemia after abdominal aortic aneurysm repair is a rare but devastating complication that appears to be random, unpredictable and until now no measures are available to completely prevent this dreadful complication.