Document Detail


Spinal cord ischemia after endovascular repair of the descending thoracic aorta in a sheep model.
MedLine Citation:
PMID:  17683959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Spinal cord ischemia remains a devastating complication after thoracic aortic surgery. The aim of this study was to investigate the pathophysiology of spinal cord ischemia after thoracic aortic endografting and the role of intercostal artery blood supply for the spinal cord in a standardized animal model. METHODS: Female merino sheep were randomized to either I, open thoracotomy with cross-clamping of the descending aorta for 50 min (n=7), II, endograft implantation (TAG, WL Gore & Ass.), (n=6) or III open thoracotomy with clipping of all intercostal arteries (n=5) . CT-angiography was used to assess completion of surgical protocol and assess the fate of intercostal arteries. Tarloy score was used for daily neurological examination for up to 7 days post-operatively. Histological cross sections of the lumbar, thoracic and cervical spinal cords were scored for ischemic damage after stained with Hematoxylin-Eosin, Klüver-Barrrera and antibodies. Exact Kruskall-Wallis-Test was used for statistical assessment (p<0.05). RESULTS: Incidence of paraplegia was 100% in group I and 0% in group II (p=0.0004). When compared to the endovascular group, there was a higher rate of histological changes associated with spinal cord ischemia in the animals of the control group (p=0.0096). Group III animals showed no permanent neurological deficit and only 20% infarction rate (p=0.0318 compared to group I). CONCLUSIONS: In sheep, incidence of histological and clinical ischemic injury of the spinal cord following endografting was very low. Complete thoracic aortic stent-grafting was feasible without permanent neurologic deficit. Following endovascular coverage or clipping of their origins, there is retrograde filling of the intercostal arteries which remain patent.
Authors:
D Böckler; D Kotelis; P Kohlhof; H von Tengg-Kobligk; U Mansmann; W Zink; C Hörner; I Ortlepp; A Habel; H-U Kauczor; B Graf; J-R Allenberg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-08-01
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  34     ISSN:  1078-5884     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-21     Completed Date:  2007-11-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  461-9     Citation Subset:  IM    
Affiliation:
Department of Vascular and Endovascular Surgery, Biomedical Research Institution, Ruprecht-Karls University, Heidelberg, Germany. dittmar_boeckler@med.uni-heidelberg.de
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MeSH Terms
Descriptor/Qualifier:
Animals
Aorta, Thoracic / radiography,  surgery*
Arteries / surgery
Blood Vessel Prosthesis Implantation / adverse effects*
Female
Immunohistochemistry
Infarction / etiology
Models, Animal
Neurologic Examination
Paraplegia / etiology
Random Allocation
Sheep
Spinal Cord / blood supply,  pathology
Spinal Cord Ischemia / etiology*
Thoracotomy
Tomography, X-Ray Computed

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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