Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?

Etz, Christian D.; Homann, Tobias; Plestis, Konstadinos A.; Zhang, Ning; Luehr, Maximilian; Weisz, Donald J.; Kleinman, George; Griepp, Randall B.

doi:10.1016/j.ejcts.2007.01.023

Cited by 75 publications

(62 citation statements)

References 21 publications

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“…Fortunately, we did not observe spinal ischemia in this series. Additionally, experimental and clinical data support the hypothesis, that spinal ischemia is mainly induced by prolonged periods of systemic hypotension and not by the number of patent intercostals arteries [14,15]. Finally, cerebrospinal fluid drainage during and within the first 72 h after stent-graft placement may serve as a valuable adjunct in avoiding this serious adverse event [16].…”

Section: Commentmentioning

confidence: 91%

Mid-term results after endovascular stent-graft placement due to penetrating atherosclerotic ulcers of the thoracic aorta☆

Gottardi

Zimpfer

Funovics

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Section: Commentmentioning

confidence: 91%

Mid-term results after endovascular stent-graft placement due to penetrating atherosclerotic ulcers of the thoracic aorta☆

Gottardi

Zimpfer

Funovics

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…Experimental studies have demonstrated that the collateral network undergoes remodelling after extensive segmental artery sacrifice with an increase in the diameter of the spinal artery within 24 h and further enlargement by nearly 100% within 5 days [19]. Similarly, the pressure measured in the distal stump of the sacrificed segmental artery shows a nadir several hours postoperatively, increases to 60% of preoperative levels by 48 h and recovers to preoperative values at 5 days [20].…”

Section: Discussionmentioning

confidence: 98%

Thoracic endovascular repair first for extensive aortic disease: the staged hybrid approach

Vivacqua

Idrees

Johnston

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES: Repair of extensive aortic disease carries a significant risk of death and morbidity, the most feared complication being spinal cord ischaemia. Objectives of this study are to characterize patients, describe repair methods and assess feasibility and safety of hybrid staged repair for treatment of extensive aortic disease. METHODS:From to 2001 to 2013, 22 patients underwent extensive aortic repair that included a thoracic endovascular aortic repair (TEVAR) first followed by an open completion repair extending through the visceral and infrarenal aorta for degenerative aneurysm and dissection. At the time of initial repair, all patients were deemed to be at a high risk for conventional open repair and had extensive disease. Indications for open completion included emergency failure of TEVAR (n = 3), early two-stage approach (n = 6) and delayed disease progression after TEVAR (n = 13). The median interval between stages was 6.5 months. The mean age was 56 ± 14 years, 5 patients had connective tissue disorder and the mean maximum aortic diameter was 58 ± 16 mm preoperatively. RESULTS:There was no death or major complication after initial TEVAR, but the operative mortality rate was 9% (n = 2) after the open procedure. One of these patients died from intraoperative myocardial infarction during emergency repair, and the other had disseminated intravascular coagulation during delayed repair for disease progression after TEVAR. Other complications included paralysis in 1 (4.5%), tracheostomy in 2 (9%) and dialysis in 1 (4.5%), and there was 1 reoperation for bleeding (4.5%). The median follow-up was 37 (range 3.3-93) months and there were no late deaths. There were four late reoperations for proximal disease progression leading to Type 1 endoleak (n = 2), Type A dissection (n = 1) and root aneurysm (n = 1). CONCLUSIONS:Use of a TEVAR-first approach in combination with a staged open repair is a safe and feasible treatment strategy for repair of extensive aortic disease. A staged hybrid approach to aortic repair in patients at high risk for total aortic replacement may limit morbidity.

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“…Against the longstanding doctrine that the major spinal cord blood-supplying vessel is located at the thoraco-abdominal transition, experimental and clinical work have shown that the spinal cord blood supply is supported by a complex network of several contributing major vascular territories [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta☆

Gottardi

Dumfarth

Holfeld

et al. 2010

European Journal of Cardio-Thoracic Surgery

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Extensive stent-graft coverage of the entire thoracic aorta can be performed with a high rate of success. If collateral blood supply to the spinal cord is maintained, occlusion of the intercostal arteries does not cause symptomatic malperfusion. However, if acute or chronic occlusion of the subclavian, lumbar or hypogastric arteries is present, likelihood of symptomatic malperfusion dramatically increases.

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Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?

Cited by 75 publications

References 21 publications

Mid-term results after endovascular stent-graft placement due to penetrating atherosclerotic ulcers of the thoracic aorta☆

Mid-term results after endovascular stent-graft placement due to penetrating atherosclerotic ulcers of the thoracic aorta☆

Thoracic endovascular repair first for extensive aortic disease: the staged hybrid approach

Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta☆

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