Document Detail


Neurophysiological monitoring during thoracoabdominal aortic endovascular stent graft implantation.
MedLine Citation:
PMID:  16439144     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim of this study was to evaluate the benefit of neurophysiological monitoring during thoracic and thoracoabdominal endovascular stent graft implantation. METHODS: The spinal cords of 21 patients undergoing endovascular stent graft implantation on the thoracic and thoracoabdominal aorta were monitored with transcranial motor-evoked potentials (tcMEP) and somatosensory-evoked potentials (SSEP). All patients underwent mild systemic hypothermia (34-35 degrees C), constant cerebrospinal fluid (CSF) pressure and vital parameter monitoring. If CSF pressure exceeded 15 mmHg, CSF-drainage was carried out. RESULTS: Three of the 21 patients (14%) exhibited short-term loss of tcMEP and SSEP after the deployment of the self-expanding endoprosthesis. We observed an intraoperative recovery of the evoked potentials in all cases. CSF-drainage was necessary in three of them. One patient, whose potentials were stable intraoperatively, developed paraparesis 3 weeks after the intervention. CONCLUSIONS: Neurophysiological monitoring has proved to be an ideal monitoring method to detect spinal cord ischemia during thoracic and thoracoabdominal endovascular stent graft implantation. Due to the advantages of endovascular therapy (no aortic cross-clamping, continuous distal perfusion, and no reperfusion injury), changes in potentials were seldom observed.
Authors:
Ernst Weigang; Marc Hartert; Michael P Siegenthaler; Katrin Pitzer-Hartert; Maximilian Luehr; Ronen Sircar; Patrick von Samson; Friedhelm Beyersdorf
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2006-01-24
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  29     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-02-13     Completed Date:  2006-04-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  392-6     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. weigang@ch11.ukl.uni-freiburg.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anesthesia, General / methods
Aortic Aneurysm, Abdominal / radiography,  surgery*
Aortic Aneurysm, Thoracic / radiography,  surgery*
Blood Vessel Prosthesis Implantation / adverse effects*,  methods
Electric Stimulation / methods
Evoked Potentials, Motor
Evoked Potentials, Somatosensory
Female
Humans
Intraoperative Complications / diagnosis
Male
Middle Aged
Monitoring, Intraoperative / methods*
Postoperative Complications / prevention & control
Spinal Cord / physiopathology
Spinal Cord Ischemia / diagnosis*,  etiology,  prevention & control
Stents
Treatment Outcome

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