Document Detail

Spinal cord ischemia may be reduced via a novel technique of intercostal artery revascularization during open thoracoabdominal aneurysm repair.
MedLine Citation:
PMID:  17681708     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To describe a novel technique for maximal reimplantation of intercostal arteries during thoracoabdominal aortic aneurysm repair.
METHODS: Eight patients underwent thoracoabdominal aortic aneurysm (TAAA) repair with this new technique from 2005 to 2006. Follow-up ranged from 6 to 14 months. All patients had a previous type B dissection with subsequent aneurysmal degeneration into an extent I TAAA. Aneurysm repair was performed through a thoracoabdominal incision and circulatory arrest in seven and left atrial-left femoral (LA-FA) bypass in one. The grafts extended from the distal arch at the subclavian artery to the visceral and renal arteries. An 8 mm graft was then extended from the proximal to the distal graft with a spatulation of the graft allowing a side-to-side anastomosis of the graft to the posterior aortic wall incorporating multiple pairs of intercostal arteries. Intraoperative electroencephalogram (EEG) and somatosensory evoked potentials (SSEP) were monitored during each operation.
RESULTS: All patients were ambulatory at the time of admission. One patient had suffered a previous spinal cord infarction from the original dissection and had residual unilateral leg weakness prior to the TAAA repair. There was an average of seven pairs of patent intercostal arteries upon opening the aorta. We reimplanted an average of five pairs of vessels. There were no perioperative complications. No patients sustained transient or permanent paraplegia in the postoperative or follow-up period. The one patient with preoperative leg weakness had reported subjective increased strength in the affected leg after the operation. In four cases, normalization of SSEP waveforms did not occur until after reimplantation of the intercostal arteries despite full return of EEG waveforms, restoration of lower extremity perfusion, and rewarming of the patient. Follow-up CT scan angiogram demonstrated that all reconstructions were patent through the follow-up period.
CONCLUSIONS: Paraplegia is an extremely morbid complication associated with TAAA repair. We describe a technique that allows reimplantation of almost all intercostal arteries as one patch circumventing the need for selective reimplantation. Furthermore, our technique ensures continued patency of this patch graft as the outflow resistance is decreased by creating a continuous flow loop. Although this is a small case series, we had no incidence of acute or delayed paraplegia in this high risk group. Our technique of intercostal reimplantation is applicable to all open TAAA repair at high-risk for paraplegia and may be an important adjunct in preventing spinal cord ischemia.
Edward Y Woo; Michael Mcgarvey; Benjamin M Jackson; Joseph E Bavaria; Ronald M Fairman; Albert Pochettino
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Publication Detail:
Type:  Journal Article     Date:  2007-07-30
Journal Detail:
Title:  Journal of vascular surgery     Volume:  46     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-10     Completed Date:  2007-10-09     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  421-6     Citation Subset:  IM    
Division of Vascular Surgery, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
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MeSH Terms
Aortic Aneurysm, Abdominal / complications,  radiography,  surgery*
Aortic Aneurysm, Thoracic / complications,  radiography,  surgery*
Evoked Potentials, Somatosensory
Follow-Up Studies
Middle Aged
Monitoring, Intraoperative
Retrospective Studies
Spinal Cord Ischemia / diagnosis,  etiology,  surgery*
Thoracic Arteries / transplantation*
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures / methods*
Comment In:
J Vasc Surg. 2008 Jan;47(1):244   [PMID:  18178483 ]

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

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