| Prevention of paraplegia in pigs by selective segmental artery perfusion during aortic cross-clamping. | |
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MedLine Citation:
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PMID: 10876219 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: During thoracoabdominal aortic aneurysm repair, a prolonged interruption of the spinal cord blood supply can result in irreversible spinal cord damage. The aim of this study was to investigate whether selective segmental artery perfusion during aortic clamping could prevent paraplegia in pigs. METHODS: Specially designed segmental artery perfusion catheters, which could be attached to an extracorporeal bypass graft system, were used. In experiment I (n = 10), it was assessed whether selective segmental artery perfusion could reverse electrophysiologic evidence of spinal cord ischemia and maintain transcranial motor evoked potentials (tc-MEPs) during 60 minutes of aortic cross-clamping. The abdominal aorta, containing critical segmental arteries, was bypassed through use of an aortoaortic bypass graft system. After the disappearance of tc-MEPs, an aortotomy was followed by selective segmental artery perfusion. In experiment II (n = 10), the aim was to determine whether selective segmental artery perfusion could prevent paraplegia. In five animals (group A), aortic cross-clamping was followed by selective segmental artery perfusion; five control animals (group B) underwent segmental artery blockade only. Postoperative hind limb function and spinal cord histopathology were evaluated on the third postoperative day. RESULTS: In experiment I, tc-MEPs disappeared within 3.7 +/- 3.7 minutes after cross-clamping and returned in all animals in 8.5 +/- 5.3 minutes after selective perfusion. During the study period, tc-MEP amplitudes recovered to a median of 49% (range, 28%-113%) of baseline values. Total bypass graft flow was 880 +/- 294 mL/min, of which 184 +/- 54 mL/min was directed to the selective perfusion catheters. The flow in individual catheters was 52 +/- 13 mL/min. In experiment II, all perfused animals demonstrated normal hind limb function, whereas four of five control animals were paraplegic on day 3 (P =.04) In the perfused animals, histopathologic examination showed either no spinal cord damage or eosinophilic neurons only, whereas in paraplegic controls there was infarction in large areas of the cord (P <.0001). CONCLUSION: In pigs, selective segmental artery perfusion can provide sufficient spinal cord blood flow to prevent paraplegia resulting from 60 minutes of aortic clamping, as shown by clinical outcomes and histopathologic examination. |
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Authors:
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S A Meylaerts; P De Haan; C J Kalkman; J Jaspers; I Vanicky; M J Jacobs |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of vascular surgery Volume: 32 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2000 Jul |
Date Detail:
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Created Date: 2000-08-02 Completed Date: 2000-08-02 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 160-70 Citation Subset: IM |
Affiliation:
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Departments of Vascular Surgery, Anesthesiology, and Medical Technical Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Aorta Aortic Aneurysm, Thoracic / surgery* Constriction Evoked Potentials, Motor Extracorporeal Circulation Female Intraoperative Complications / prevention & control* Ischemia / pathology, prevention & control* Paraplegia / prevention & control Perfusion / methods* Regional Blood Flow Spinal Cord / blood supply*, pathology, physiology Swine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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