Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms

Gravereaux, Edwin C.; Faries, Peter L.; Burks, James A.; Latessa, Victoria; Spielvogel, David; Hollier, Larry H.; Marin, Michael L.

doi:10.1067/mva.2001.119890

Cited by 281 publications

(210 citation statements)

References 21 publications

(39 reference statements)

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“…Konus bölgesinin beslenmesi ASA ve iki PSA tarafından oluşturulan anastomoz ansı ve özellikli iki arter olan T8'den conus medullarise kadar uzanan Adamkiewicz arteri ve internal iliak arterin dalı olan Desproges-Gotteron arteri tarafından sağlanır (6). Bu arterlerde kalp veya aort kaynaklı embolinin oklüzyona neden olabileceği, aort diseksiyonu sonrası gelişen flebin direkt arterin beslenmesini bozabileceği, ciddi ateroskleroz zemininde oluşan stenoz sonrası hipotansiyon gibi perfüzyon bozukluğuna neden olabilecek durumlar konus bölgesinde iskemiye neden olabilir (10).…”

Section: Discussionunclassified

Conus medullaris syndrome due to spinal cord iscemia: case report

Erdal¹,

Emre²,

Karagöz³

2017

Türk Beyin Damar Hast Derg

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ÖZETKonus medullaris sendromu bacaklarda simetrik güçsüzlük, duyu kaybı ve idrar-gaita inkontinansı ile karakterize klinik bir durumdur. Konus düzeyinde gelişen iskemi, hemoraji, tümör ya da bası bu klinik tabloya neden olabilir. Bu yazıda, bacaklarda akut gelişen güçsüzlük, idrar ve gaita inkontinansı olan ve spinal görüntülemelerinde spinal iskemi ile uyumlu bulgu saptanan 71 yaşında erkek hastayı sunmak istedik. Anahtar Sözcükler: Spinal iskemi, konus medullaris sendromu, anterior spinal arter. CONUS MEDULLARIS SYNDROME DUE TO SPINAL CORD ISCEMIA: CASE REPORT ABSTRACTConus medullaris syndrome is a clinical condition characterized by symmetrical weakness in the legs, sensory loss and urinary and fecal incontinence. At the conus level, ischemia, hemorrhage, tumor or compression may result this clinical entity. In this article, we wanted to present 71 years old patient who had bilateral acute leg weakness, urinary and fecal incontinence and it was detected the findings of spinal ischemia at spinal images. Key Words: Spinal ischemia, conus medullaris syndrome, anterior spinal artery. GİRİŞSpinal kord iskemisi nadir görülen sıklıkla ciddi klinik kötüleşmeye neden olan bir durumdur. Hastalar sıklıkla spinal kord tutulum bölgesine bağlı olarak paraparezi, kuadriparezi, duysal bulgular veya idrar ve gaita inkontinansı bulguları ile kliniğe başvurur (1). Bu yazıda, spinal kord iskemisine bağlı gelişen konus medullaris sendromu olgusu tanımlanarak bu nadir klinik tabloya dikkat çekmek amaçlanmıştır. OLGU71 yaşında erkek hasta başvurusundan iki gün önce ani başlayan kısa süreli sırt ağrısı sonrası her iki bacakta güçsüzlük ve idrar yapamama şikayeti ile hastanemize başvurdu. Şikayetleri ani başlayan hastanın, öncesinde geçirilmiş enfeksiyon, cerrahi operasyon, uzun süreli yolculuk, dehidratasyon, hipotansiyon öyküsü yoktu. Özgeçmişinde hipotiroidi, benign prostat hipertrofisi (BPH), hiperlipidemi öyküsü olan hastanın BPH ve hipotiroidiye yönelik aldığı ilaç tedavisinin dışında kullandığı ilaç yoktu. Fizik muayenesi normal sınırlarda idi. Nörolojik muayenesinde, kranial sinir muayenesi normaldi. Üst ekstremite kas gücü tamdı, her iki kalça fleksörleri 3/5, bilateral diz ekstansiyonu 4/5 kas gücündeydi, her iki ayak dorsifleksiyonu ve plantar fleksiyonu plejikti. Eyer tarzında duyu kusuru mevcuttu, seviye veren duyu kusuru yoktu ve derin duyu normaldi.

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Section: Discussionunclassified

Conus medullaris syndrome due to spinal cord iscemia: case report

Erdal¹,

Emre²,

Karagöz³

2017

Türk Beyin Damar Hast Derg

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“…Embolization into major intercostal arteries due to the manipulation of the device in the aortic lumen has also been nominated as another potential risk factor. Extended coverage of the thoracic aorta has also been proven [22,[26][27][28] to augment the risk of medullary ischemia. This risk rises further when coverage includes the region distal to T10.…”

Section: Neurological Complicationsmentioning

confidence: 99%

“…This risk rises further when coverage includes the region distal to T10. [22,25,29] The EUROSTAR [21] study reported a significantly increased incidence of paraplegia when three or more endograft segments were used (OR, 3.5; P =.043).…”

Section: Neurological Complicationsmentioning

confidence: 99%

“…[21][22][23] The medullary vascularization from the lumbar and hypogastric arteries are important contributors in the risk of paraplegia. [24] Given this information, it is therefore advised by various authors [22,25] to perform eventual treatment of the abdominal and thoracic aorta in different interventions, so that a gradual establishment of a collateral medullary vascular circuit can be established. At this centre, in cases where a long segment of the thoracic aorta is planned to be covered and the hypogastric circulation is compromised, a preventive treatment is routinely performed.…”

Section: Neurological Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Endovascular Treatment of Descending Thoracic Aortic Aneurysms

Coppi¹,

Gennai²,

Silingardi³

et al. 2013

Aortic Aneurysm - Recent Advances

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“…In 2001 Gravereaux EC, Faries PL, Burks JA et al [6] with an experience of 53 patients concluded "concomitant or previous abdominal aortic aneurysm repair and long segment thoracic aortic occlusion appear to be important risk factors (for the development of SCI). Chiesa R, Melissano G, et al [7] reported on an experience over 5 years of 103 patients elective endovascular repair of the thoracic aorta.…”

Section: What Are the Risk Factors For Spinal Cord Ischaemiamentioning

confidence: 99%

Review of Thoracic Endovascular Aneurysm Repair (TEVAR), Spinal Cord Ischemia (SCI), Cerebrospinal Fluid (CSF) Drainage and Blood Pressure (BP) Augmentation

Englund¹

2017

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The object of this review is to examine the role of TEVAR in causing SCI. The anatomy and physiology of blood flow to the spinal cord is examined. The role of auto regulation of blood flow within the spinal cord is also examined. This review examines the reported results from the scientific literature of the effect of thoracic aortic aneurysm repair on spinal cord blood flow. In the light of these findings several conclusions can reasonably be reached. These conclusions are that the development of SCI can reasonably be predicted based on complexity and extent of the TEVAR procedure performed and BP augmentation and CSF drainage can significantly reduce the impact of SCI.

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Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms

Cited by 281 publications

References 21 publications

Conus medullaris syndrome due to spinal cord iscemia: case report

Conus medullaris syndrome due to spinal cord iscemia: case report

Endovascular Treatment of Descending Thoracic Aortic Aneurysms

Review of Thoracic Endovascular Aneurysm Repair (TEVAR), Spinal Cord Ischemia (SCI), Cerebrospinal Fluid (CSF) Drainage and Blood Pressure (BP) Augmentation

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