Predicting the Risk of Paraplegia After Thoracic and Thoracoabdominal Aneurysm Repair

Zoli, Stefano; Roder, Fabian; Etz, Christian D.; Brenner, Robert; Bodian, Carol; Lin, Hung Mo; Luozzo, Gabriele Di; Griepp, Randall B.

doi:10.1016/j.athoracsur.2010.04.091

Cited by 79 publications

(46 citation statements)

References 25 publications

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“…15 Experimental work, further evidenced in clinical series, has characterized the functional elements of this network: that the spinal cord can tolerate the loss of some contributors to perfusion (but a tipping point is reached beyond which dysfunction is inevitable), that backflow from intercostals or lumbars leads to a steal phenomenon (and is controlled for by temporary balloon occlusion during open repair), and that not all collateral sources are created equally (reaffirming the relative dominance of the distal intercostals as first described by Adamkiewicz). [16][17][18] Furthermore, Etz et al 9 have demonstrated the remodeling that occurs after the loss of elements of the collateral supply. Staged repair builds on this concept of a collateral supply, through the completion of the repair in two temporally separate procedures in an effort to maximize collateralization.…”

Section: Discussionmentioning

confidence: 97%

Staged endovascular repair of thoracoabdominal aortic aneurysms limits incidence and severity of spinal cord ischemia

O’Callaghan

Mastracci

Eagleton

2015

Journal of Vascular Surgery

145

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Section: Discussionmentioning

confidence: 97%

Staged endovascular repair of thoracoabdominal aortic aneurysms limits incidence and severity of spinal cord ischemia

O’Callaghan

Mastracci

Eagleton

2015

Journal of Vascular Surgery

145

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“…The incidence of SCI following TEVAR is 3% to 10%, [59][60][61][62][63][64] which is comparable to outcomes in OSR. 65 SCI results from a disruption of the blood supply to the anterior spinal cord by the stent graft.…”

Section: Tevar and Spinal Cord Ischemia (Sci)mentioning

confidence: 64%

Anesthesia for the Endovascular Management of Aortic Disease

Vázquez

Chitilian²

2016

International Anesthesiology Clinics

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“…These methods principally include manipulation of spinal cord perfusion pressure with CSF drainage [1,2] and distal perfusion [3]. Other adjuncts include: sequential clamping/ duration of cross clamp, intercostal reattachment, hypothermia and spinal cord monitoring [4][5][6][7]. Lumbar spinal drain insertion and manipulation of spinal cord perfusion pressure is becoming a standard of care in perioperative management of patients undergoing thoracic aortic intervention.…”

Section: Introductionmentioning

confidence: 99%

The safe use of spinal drains in thoracic aortic surgery

Field¹,

Doolan²,

Safar³

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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Paraplegia is a devastating complication which may occur following surgery on the thoracic aorta. The use of a cerebrospinal fluid drain (CSFD) has helped reduce the incidence of neurological deficit; however, the management of patients with a CSFD postsurgery requires nurses and doctors to have expertise and awareness of the associated complications. The National Patient Safety Agency (UK) has highlighted a number of cases involving inadvertent spinal injections throughout the UK National Health Service (NHS). To this end we have introduced a protocol or 'care bundle' for safe CSFD care as well as drain management. The protocol was developed by medical and nursing staff at our institution based on clinical experience and literature reviews over a two-year period (2008-2010). Interventions undertaken during the development of the protocol included discussion with the UK National Patient Safety Agency (NPSA). Content of the protocol was reviewed by internal regulatory bodies within the hospital prior to ratification and general dissemination. Clear guidance is given within the policy on the standards expected when caring for the line and managing drainage according to agreed parameters of spinal cord perfusion pressure. The protocol constitutes five documents which guide staff in the care of CSFD, its routine management, documentation and interventions necessary once neurological deficit is detected. Document 1 which is a checklist, communication tool and aide-memoire was developed to ensure effective management, when the patient arrives in intensive care unit (ICU) from theatre. Document 2 ensures that early detection of a neurological deficit is noted and with Document 3 is acted upon immediately to reverse the injury. Document 4 provides information on the safe administration of analgesia via the spinal drain and has reference to the Glasgow Coma Scale. Document 5 is a bespoke observation chart for documenting CSFD pressure and cerebrospinal fluid drainage. In conclusion, the protocol acts as a guide for safe management of the CSFD and directs staff in reacting to detection of neurological deficit.

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Predicting the Risk of Paraplegia After Thoracic and Thoracoabdominal Aneurysm Repair

Cited by 79 publications

References 25 publications

Staged endovascular repair of thoracoabdominal aortic aneurysms limits incidence and severity of spinal cord ischemia

Staged endovascular repair of thoracoabdominal aortic aneurysms limits incidence and severity of spinal cord ischemia

Anesthesia for the Endovascular Management of Aortic Disease

The safe use of spinal drains in thoracic aortic surgery

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