Document Detail

Assessment of spinal cord circulation and function in endovascular treatment of thoracic aortic aneurysms.
MedLine Citation:
PMID:  17257945     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In thoracic stent graft repair, the importance of segmental artery (SA) occlusion and the role of blood pressure management during the intraoperative and directly postoperative period are not clear. To study these aspects in relation to spinal cord ischemia, our protocol in the endovascular treatment of descending thoracic aneurysms covering segmental arteries T8 and lower includes preoperative assessment of the spinal cord circulation using magnetic resonance angiography, intraoperative cerebrospinal fluid drainage, and spinal cord function monitoring using motor evoked potentials (MEPs). METHODS: Thirteen patients with thoracic aortic aneurysms and dissections needing stent graft coverage of T8 and lower were included. In 9 patients, spinal cord circulation was evaluated preoperatively by magnetic resonance angiography. In 12 patients, MEPs were recorded during the endovascular procedure. A combination of both techniques was used in 8 patients. RESULTS: The distal stent graft landing zone covered the intercostal arteries up to T10 in 4 patients, up to T11 in 7 patients, up to T12 in 1 patient, and all SAs to the aortic bifurcation in 1 patient. In 6 patients, the SA feeding the Adamkiewicz artery was covered by the stent graft. In three patients, intersegmental collaterals were present to the SA feeding the Adamkiewicz artery. The MEPs decreased to 50% and 30% in 2 patients, recovering to levels above 50% by elevation of the mean arterial pressure. Postoperatively, no signs of paraplegia were present. CONCLUSIONS: We believe that the presence of intersegmental collaterals decreases the risk of spinal cord ischemia during endovascular thoracic aortic aneurysm repair. Monitoring of MEPs during endovascular thoracic procedures shows no decrease in most cases. However, if a decrease of MEPs occurs, this can be reversed by elevation of the mean arterial pressure.
Geert Willem H Schurink; Robbert J Nijenhuis; Walter H Backes; Werner Mess; Michiel W de Haan; Bas Mochtar; Michael J Jacobs
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-29     Completed Date:  2007-03-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  S877-81; discussion S890-2     Citation Subset:  AIM; IM    
Department of Vascular Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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MeSH Terms
Aortic Aneurysm, Thoracic / diagnosis,  physiopathology*,  therapy*
Blood Pressure
Collateral Circulation
Evoked Potentials, Motor
Intercostal Muscles / blood supply
Magnetic Resonance Angiography
Monitoring, Intraoperative*
Regional Blood Flow
Spinal Cord / blood supply*,  physiopathology*
Thoracic Vertebrae

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