Editor's Choice – Spinal Cord Ischaemia in Endovascular Thoracic and Thoraco-abdominal Aortic Repair: Review of Preventive Strategies

Dijkstra, Martijn; Vainas, Tryfon; Zeebregts, Clark J.; Hooft, Lotty; Laan, Maarten J. van der

doi:10.1016/j.ejvs.2018.02.002

Cited by 64 publications

(39 citation statements)

References 35 publications

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“…The reduction of the E-vita Open stent graft length from 15 to 13 cm and the implementation of distal body selective perfusion during the study period may have contributed to the observed reduction of spinal cord complications (23,25). Nowadays, FET surgery can be applied with similar results in comparison to classic open aortic arch surgery and with a less residual risk for spinal cord complication, close to that observed during endovascular stent graft therapy (26,27).…”

Section: Figurementioning

confidence: 80%

Results of frozen elephant trunk from the international E-vita Open registry

Tsagakis¹,

Pacini²,

Grabenwöger³

et al. 2020

Ann Cardiothorac Surg

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Background: Over the years, frozen elephant trunk (FET) has become the treatment of choice for multisegmental thoracic aortic disease. This multicenter study presents the evolution of FET results using the E-vita Open hybrid graft with respect to institutional experience and time. Methods: The data of International E-vita Open registry were studied according to the institutional experience of the participating centers (high-versus low-volume centers) and according to the evolution of FET treatment during time (1 st period, 2005-2011 versus 2 nd period, 2012-2018). Overall, 1,165 patients were enrolled in the study with a wide variety of multisegmental thoracic aortic pathologies and aortic emergencies. Participating centers determined their own surgical protocol. Results: The overall 30-day mortality was 12%. Short-and long-term survival were higher in high-versus low-volume centers (P=0.048 and P=0.013, respectively). In the 2 nd time period, cerebral complications were reduced significantly (P=0.015). Incidence of permanent spinal cord-related symptoms was reduced to 3% in the 2 nd time period, but did not reach statistical significance. Hypothermic circulatory arrest time (P<0.001) and incidence of postoperative temporary renal replacement therapy (P=0.008) were significantly reduced in the 2 nd time period. Ten-year survival and freedom from aortic-related death rates were 46.6% and 85.7%, respectively, for the entire group. The freedom from distal aortic re-interventions for a new or progressive residual aortic disease was 76.0%. Conclusions: Evolution of FET arch repair techniques with the E-vita Open graft and increasing institutional experience were associated with improved results. Progression of residual aortic disease makes close follow-up with aortic imaging mandatory in such patients.

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Section: Figurementioning

confidence: 80%

Results of frozen elephant trunk from the international E-vita Open registry

Tsagakis¹,

Pacini²,

Grabenwöger³

et al. 2020

Ann Cardiothorac Surg

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“…The risk of SCI with coverage of thoracic aorta using stent graft has been documented in the treatment of aortic aneurysms, a reported incidence between 3 and 11%. 66,67 In case of BAI, the distal coverage is usually shorter compared with aneurysmal disease. The main supply of the spinal cord arises from the artery of Adamkiewicz which arises much lower, commonly between T9 and T12 vertebral level.…”

Section: Spinal Cord Ischemiamentioning

confidence: 99%

Thoracic Trauma: Aortic Injuries

Monga

Patil

Cherian

et al. 2021

Semin intervent Radiol

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Thoracic aortic injuries caused by high impact trauma are life-threatening and require emergent diagnosis and management. With improvement in the acute care services, an increasing number of such injuries are being managed such that patients survive to undergo definitive therapies. A high index of clinical suspicion is required to order appropriate imaging. Computed tomography angiography is used to classify the injuries and guide treatment strategy. While low-grade injuries might be managed conservatively, high-grade injuries require urgent surgical or endovascular intervention. Over the past decade, endovascular repair of the thoracic aorta with or without a surgical bypass has become the preferred treatment with reduced mortality and morbidity. Rapid advancements in the stent graft technology have reduced the anatomic barriers to endovascular therapy and increased the confidence of the operators. Detailed planning prior to the procedure, understanding of the anatomy, correct choice of hardware, and adherence to technical protocol are essential for a successful endovascular procedure. These patients are often young and the limited data on the long-term outcome of aortic stent grafts make a case for a robust follow-up protocol.

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“…2 Estimates of the incidence of SCI in this setting vary widely, ranging from 0.3% to 21%. 3 When it occurs, SCI is often devastating-for example, the 30-day mortality of patients who suffer SCI after thoracic aortic surgery is almost triple that of those who do not and approaches 40%, 4 whereas as many as 3% suffer permanent paraplegia. 5 Given this reality, a pharmacologic intervention that prevents or mitigates SCI is tantalizing indeed.…”

mentioning

confidence: 99%

“…There is a high degree of variability, and in the diseased aorta, additional collaterals may play a critical role in maintaining spinal cord perfusion. 3 SCI results from either temporary interruption of spinal cord blood supply (as seen during aortic crossclamping) or permanent interruption (secondary to replacement or exclusion of a segment of the aorta that feeds the vessels that perfuse the spinal cord). The anatomic variability of the blood supply makes prediction and prevention of SCI difficult, despite advances in surgical technique.…”

mentioning

confidence: 99%

“…A recent review of the literature suggests that only hypothermia, avoidance of hypotension, and intraoperative neuromonitoring demonstrate modest positive effects. 3 Once ischemia occurs, astrocyte activation and hypertrophy (termed astrocytosis) occur. Astrocytosis is a natural part of the healing process after neuronal injury, but has been shown to result in reduced regeneration of neuronal synapses.…”

mentioning

confidence: 99%

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