Document Detail

Thoracic and thoracoabdominal aneurysm repair: is reimplantation of spinal cord arteries a waste of time?
MedLine Citation:
PMID:  17062225     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The impact of different strategies for management of intercostal and lumbar arteries during repair of thoracic and thoracoabdominal aortic aneurysms (TAA/A) on the prevention of paraplegia remains poorly understood. METHODS: One hundred consecutive patients with intraoperative monitoring of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) during TAA/A repair involving serial segmental artery sacrifice (October 2002 to December 2004) were reviewed. RESULTS: Operative mortality was 6%. The median intensive care unit stay was 2.5 days (IQ range: 1-4 days), and the median hospital stay 10.0 days (IQ range: 8-17 days). Potentials remained unchanged during the course of serial segmental artery sacrifice, or could be returned to baseline levels by anesthetic and blood pressure manipulation, in 99 of 100 cases. An average of 8.0 +/- 2.6 segmental artery pairs were sacrificed overall, with an average of 4.5 +/- 2.1 segmental pairs sacrificed between T7 and L1, where the artery of Adamkiewicz is presumed to arise. Postoperative paraplegia occurred in 2 patients. In 1, immediate paraplegia was precipitated by an intraoperative dissection, resulting in 6 hours of lower body ischemia. A second ambulatory patient had severe paraparesis albeit normal cerebral function after resuscitation from a respiratory arrest. CONCLUSIONS: With monitoring of MEP and SSEP, sacrifice--without reimplantation--of as many as 15 intercostal and lumbar arteries during TAA/A repair is safe, resulting in acceptably low rates of immediate and delayed paraplegia. This experience suggests that routine surgical implantation of segmental vessels is not indicated, and that, with evolving understanding of spinal cord perfusion, endovascular repair of the entire thoracic aorta should ultimately be possible without spinal cord injury.
Christian D Etz; James C Halstead; David Spielvogel; Rohit Shahani; Ricardo Lazala; Tobias M Homann; Donald J Weisz; Konstadinos Plestis; Randall B Griepp
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  82     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-25     Completed Date:  2006-11-14     Revised Date:  2008-10-10    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1670-7     Citation Subset:  AIM; IM    
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA.
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MeSH Terms
Aged, 80 and over
Aortic Aneurysm, Abdominal / surgery*
Aortic Aneurysm, Thoracic / surgery*
Arteries / surgery
Blood Vessel Prosthesis Implantation / adverse effects,  methods*
Evoked Potentials, Motor
Evoked Potentials, Somatosensory
Middle Aged
Monitoring, Intraoperative
Paraplegia / etiology,  prevention & control*
Replantation / adverse effects*
Retrospective Studies
Spinal Cord / blood supply,  physiology
Comment In:
Perspect Vasc Surg Endovasc Ther. 2008 Jun;20(2):221-3   [PMID:  18644815 ]
Ann Thorac Surg. 2006 Nov;82(5):1677-8   [PMID:  17062226 ]

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