Clinical experience with epidural cooling for spinal cord protection during thoracic and thoracoabdominal aneurysm repair

Abstract

EC is a safe and effective technique to increase the ischemic tolerance of the spinal cord during TA or TAA repair. When used in conjunction with a clamp-and-sew technique and a strategy of selective intercostal reanastomosis, EC has significantly reduced the incidence of neurologic deficits after TAA repair.

Spinal Cord Protection for Descending or Thoracoabdominal Aortic Aneurysm Repair

“…[65]; in which, normal saline at 4°C is continuously infused into the epidural space through a catheter. Using epidural cooling with CSF drainage, segmental artery reimplantation, and almost exclusive use of a clamp-and-sew technique without distal bypass ( 98% of patients), Cambria et al [66] reported a paraplegia rate of 2% in 170 cases.…”

Rehabilitation for Spinal Cord Injury Caused by Thoracic Aortic Aneurysm

“…Various methods have been devised to protect against spinal cord ischemia during surgery for TAA (Bicknell et al, 2009;Tabayashi, 2005), such as cerebrospinal fluid drainage (Acher et al, 1994;Coselli, et al, 2002;Fedorow et al, 2010;Griepp et al, 1996;Griepp & Griepp, 2007), hypothermia (Griepp et al, 1996), epidural cooling (Cambria et al, 1997), monitoring of somatosensory (SSEP) (Crawford et al, 1988) and motor evoked potentials (MEP) (de Haan et al, 1997;Jacobs et al 2006), intercostal artery reattachment (Acher et al, 2008), distal aortic perfusion (Crawford et al, 1988;Safi et al, 2003), and direct spinal cord cooling (Davison et al, 1994). Spinal cord perfusion is regulated according to the following formula,…”

Contemporary Management of Descending Thoracic and Thoracoabdominal Aortic Aneurysms: Endovascular Versus Open

“…In an effort to minimize this risk, we developed and applied a technique for the provision of regional hypothermic protection to that segment of the spinal cord typically at risk for ischemic injury during TA/TAA repair that involves an epidural infusion of iced saline during aortic crossclamping. 38,39 Other adjuncts aimed at reducing the risk of paraplegia include cerebrospinal fluid drainage, 40 reimplantation of patent critical intercostal arteries (those that actively bleed after the aneurysm has been opened), the use of evoked-potential monitoring, 41 and atriofemoral bypass to maintain distal aortic perfusion. SCI remains an unsolved problem despite considerable improvements in the overall incidence of this complication.…”