Spinal Cord Protection for Thoracoabdominal Aortic Surgery

Miller, Lydia; Patel, Virendra I.; Wagener, Gebhard

doi:10.1053/j.jvca.2021.06.024

Cited by 15 publications

(11 citation statements)

References 50 publications

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“…Cerebrospinal fluid drainage (CSFD) and mean arterial pressure augmentation are relatively effective methods for the prevention of SCI in thoracoabdominal aortic aneurysm (TAAA) repair. However, although CSFD is recommended as an effective method for the prevention of SCI in open TAAA repair, there is currently no strong evidence to support its effectiveness in TEVAR [ 9 ]. Because of the non-negligible rates of reported complications associated with CSFD, such as neuraxial hematoma, intracranial bleeding and meningitis, we do not routinely use CSFD.…”

Section: Discussionmentioning

confidence: 99%

Distal aortic replacement followed by endovascular repair for the management of severe intra-pleural adhesions accidentally detected during open surgery for chronic type B aortic dissection: a report of two cases

Daimon

Shimada

Motohashi

et al. 2022

J Cardiothorac Surg

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Background Open repair is the most promising curative treatment option for patients with chronic type B aortic dissection. However, based on our experience, following the accidental detection of intra-pleural adhesions during open surgery for chronic type B aortic dissection, complete replacement of the diseased aorta cannot be accomplished. To overcome this problem, we switched the procedure to create a distal landing zone for subsequent endovascular repair by replacing the distal aorta with a vascular graft. Case presentation We report two cases in which open repair was attempted; however, the proximal descending thoracic aorta could not be exposed due to the presence of severe adhesion in the pleural cavity. In these patients, we accessed the lower descending thoracic aorta or thoracoabdominal aorta and created a distal landing zone for subsequent endovascular repair by replacing the aorta with a vascular graft. Thereafter, endovascular repair was performed with good outcomes. Conclusions Replacement of the distal aorta, which is typically easy to access despite the presence of intra-pleural adhesions, with a vascular graft serves as a reliable distal landing zone for subsequent endovascular repair. This method may be a viable option for the management of severe adhesions accidentally detected in the pleural cavity during open repair for chronic type B aortic dissection.

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Section: Discussionmentioning

confidence: 99%

Distal aortic replacement followed by endovascular repair for the management of severe intra-pleural adhesions accidentally detected during open surgery for chronic type B aortic dissection: a report of two cases

Daimon

Shimada

Motohashi

et al. 2022

J Cardiothorac Surg

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show abstract

“…Spinal cord ischemia can lead to postoperative paraplegia during major aortic surgery (Miller, Patel et al 2021). Fang et al (Fang, Roan et al 2021) showed that after spinal cord ischemia, allogenic mitochondria harvested from skeletal muscle delivered via the internal jugular vein improved lower-limb locomotor function of rats that were subjected to spinal cord ischemia up to seven days after surgery.…”

Section: Applications Of Mitochondrial Transplantation In Treatment O...mentioning

confidence: 99%

Prospects of mitochondrial transplantation in clinical medicine: Aspirations and challenges

2022

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“…Thus, the extent of aortic coverage by the stent is probably the most important factor when calculating the risk of spinal cord injury [10]. Patientrelated risk factors for spinal cord injury include advanced age (>70 y); peri-operative hypotension; renal insufficiency; chronic obstructive pulmonary disease; and hypertension [4,9,[11][12][13][14]. The goal of spinal cord drainage is to decrease CSF pressure (<10 mmHg) to maintain spinal cord perfusion with the concomitant increase in MAP (>90 mmHg).…”

Section: Aortic Dissectionmentioning

confidence: 99%

Anaesthesia for vascular emergencies – a state of the art review

et al. 2022

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Summary In this state‐of‐the‐art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre‐operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri‐operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID‐19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri‐operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post‐procedural evaluation.

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Spinal Cord Protection for Thoracoabdominal Aortic Surgery

Cited by 15 publications

References 50 publications

Distal aortic replacement followed by endovascular repair for the management of severe intra-pleural adhesions accidentally detected during open surgery for chronic type B aortic dissection: a report of two cases

Distal aortic replacement followed by endovascular repair for the management of severe intra-pleural adhesions accidentally detected during open surgery for chronic type B aortic dissection: a report of two cases

Prospects of mitochondrial transplantation in clinical medicine: Aspirations and challenges

Anaesthesia for vascular emergencies – a state of the art review

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