Endovascular procedures for the treatment of autonomic dysfunction

Gibbons, Christopher H.; Cheshire, William P.; Barboi, Alexandru; Levine, Benjamin D.; Olshansky, Brian; Kinsella, Laurence J.; Claydon, Victoria E.; Crandall, Craig G.; Fink, Gregory D.; Joyner, Michael J.; Macefield, Vaughan G.; Freeman, Roy; Raj, Satish R.; Stewart, Julian M.; Sandroni, Paola; Kaufmann, Horacio; Chelimsky, Thomas C.

doi:10.1007/s10286-013-0217-7

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…Along with the well-known motor and sensory deficits, injury to these structures can be expected to result in corresponding autonomic disturbances. 13 , 14 The autonomic nervous system, via its sympathetic and parasympathetic divisions, regulates circulatory function such as blood pressure and pulse. 15 The sympathetic division is also responsible for increasing heart rate and peripheral vascular resistance through vasoconstriction.…”

Section: Discussionmentioning

confidence: 99%

Vasoplegia Following Complex Spine Surgery: Incidence and Risk

Ishak

Pulido

Glinski

et al. 2022

Global Spine Journal

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Study design Retrospective cohort study Objectives Vasoplegia is a life-threatening form of distributive or vasodilatory shock that is characterized by reduced systemic vascular resistance with resultant hypotension and normal to elevated cardiac output affecting morbidity and mortality. Vasoplegia in the context of Spine Surgery has not been described previously. The purpose of this case series is to determine incidence, risk factors, complications and postoperative outcome in patients with vasoplegia after complex multi-level thoraco-lumbar spine surgery. Methods A retrospective review of the electronic medical records at our institution was conducted between January 2014 and June 2018. All patients undergoing multi-level spine surgery (>6 levels) were screened for intraoperative hypotension. Patient demographics, surgical characteristics, neurological status, blood loss, risk factors, medical treatment, complications, hospital course and mortality were collected. All patients included in this study had a minimum follow-up period of 3 months. Results Out of 8521 surgically treated patients, 994 patients with multi-level thoraco-lumbar spine surgery were identified. A total of 41 patients had intraoperative hypotensive events. Of those, 5 patients with vasoplegia could be identified after elimination of all other potential contributing factors. Vasoplegia did not influence the neurological outcome. One major and three minor complications occurred. All patients showed full recovery. The risk factors identified for vasoplegia include prolonged surgery with osteotomies. Conclusions Vasoplegia is a rare condition with an incidence of .6%. Patients experiencing vasoplegia did not appear to experience worse surgical outcomes. The use of special intraoperative hemodynamic monitoring should be considered in selected cases.

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Section: Discussionmentioning

confidence: 99%

Vasoplegia Following Complex Spine Surgery: Incidence and Risk

Ishak

Pulido

Glinski

et al. 2022

Global Spine Journal

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“…Previously several invasive and noninvasive procedures and intervention been used for the treatment of POTS but has no longer been used due to high risk and lack of efficacy like Vagal nerve stimulation, radiofrequency sinus node modification, and thoracic venous system endovascular intervention [65,92,93].…”

Section: Treatments No Longer Indicatedmentioning

confidence: 99%

COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review

Mallick¹,

Goyal²,

Chourasia³

et al. 2023

Cureus

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POTS (Postural Orthostatic Tachycardia Syndrome) is a multisystem disorder characterized by the abnormal autonomic response to an upright posture, causing orthostatic intolerance and excessive tachycardia without hypotension. Recent reports suggest that a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months of infection. Prominent symptoms of POTS include fatigue, orthostatic intolerance, tachycardia, and cognitive impairment. The exact mechanisms of post-COVID-19 POTS are unclear. Still, different hypotheses have been given, including autoantibody production against autonomic nerve fibers, direct toxic effects of SARS-CoV-2, or sympathetic nervous system stimulation secondary to infection. Physicians should have a high suspicion of POTS in COVID-19 survival when presented with symptoms of autonomic dysfunction and should conduct diagnostic tests like the Tilt table and others to confirm it. The management of COVID-19-related POTS requires a comprehensive approach. Most patients respond to initial non-pharmacological options, but when the symptoms become more severe and they do not respond to the non-pharmacological approach, pharmacological options are considered. We have limited understanding and knowledge of post-COVID-19 POTS, and further research is warranted to improve our understanding and formulate a better management plan.

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Endovascular procedures for the treatment of autonomic dysfunction

Cited by 2 publications

References 9 publications

Vasoplegia Following Complex Spine Surgery: Incidence and Risk

Vasoplegia Following Complex Spine Surgery: Incidence and Risk

COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review

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