Spinal cord injury following thoracic and thoracoabdominal aortic repairs

@article{Panthee2015SpinalCI,
  title={Spinal cord injury following thoracic and thoracoabdominal aortic repairs},
  author={Nirmal Panthee and Minoru Ono},
  journal={Asian Cardiovascular and Thoracic Annals},
  year={2015},
  volume={23},
  pages={235 - 246}
}
  • N. Panthee, M. Ono
  • Published 2015
  • Medicine
  • Asian Cardiovascular and Thoracic Annals
Objective To discuss the currently available approaches to prevent spinal cord injury during thoracic and thoracoabdominal aortic repairs. Methods We carried out a PubMed search up to 2013 using the Medical Subject Headings: “aortic aneurysm/surgery” and “spinal cord ischemia”; “aortic aneurysm, thoracic/surgery” and “spinal cord ischemia”; “aneurysm/surgery” and “spinal cord ischemia/cerebrospinal fluid”; “aortic aneurysm/surgery” and “paraplegia”. All 190 original articles satisfying our… Expand
Preventing spinal cord injury during thoracic aortic surgery: simpler than we thought?
TLDR
Experimental and clinical assessment of the adequacy of partial bypass in maintenance of spinal cord blood flow during operations on the thoracic aorta and the role of the sympathetic nervous system in spinal cord autoregulation are evaluated. Expand
Paraspinous muscle gene expression profiling following simulated staged endovascular repair of thoracoabdominal aortic aneurysm: exploring potential therapeutic pathways†.
  • E. Lewis, S. Geisbuesch, +5 authors G. Di Luozzo
  • Medicine
  • European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
  • 2019
TLDR
This study demonstrates the ability of microarray-based platforms to detect the differential expression of genes in paraspinous muscle during staged TAAA repair and provides new insight into the potential prognostic and therapeutic value of gene expression profiling in monitoring and modulating the arteriolar remodelling in the collateral network. Expand
Endovascular treatment of synchronous and metachronous aneurysms of the thoracic aorta. Is there an increase in the procedural risk
TLDR
The present study analyzes the experience in the management of SA and MA in patients submitted to thoracic endovascular aneurysm repair (TEVAR) between March 2009 and February 2015 and finds the prevalence of SA in all the TEVAR cases was 18.9%. Expand
MicroRNAs: Panacea or Pandora's box?
  • P. Kurlansky
  • Medicine
  • The Journal of thoracic and cardiovascular surgery
  • 2015
TLDR
The observation that thoracic endovascular aneurysm repair carries the same risk of paraplegia as open procedures supports the observation that spinal cord ischemia is primarily a matter of collateral blood flow and ischemic tolerance, rather than assisted circulation and selective intercostal reattachment, supporting the relative importance of cerebrospinal fluid drainage and maintenance of perfusion pressure relative to other techniques. Expand
The attenuation of neurological injury from the use of simvastatin after spinal cord ischemia-reperfusion injury in rats
TLDR
The results of the current study suggest that 10 mg/kg can significantly improve neurologic outcome by attenuating neurologic injury and restoring normal motor neurons after spinal cord IR injury. Expand
The significance of the pelvic collateral circulation in aorto‐iliac disease
TLDR
The systemic pelvic collateral circulation should be explored in detail, especially in relation to postoperative complications following open and endovascular aortic aneurysm repairs, as well as the anatomical basis of arterial hypoperfusion of the distal spinal cord. Expand
Neuroprotection during aortic surgery.
TLDR
The evidence for established and emerging strategies to prevent or treat neurological injury is summarized, and current concepts in pathophysiology and risk assessment as they relate to neurological injury are reviewed. Expand
Neurologic complications of polytrauma.
TLDR
In polytrauma, the neurologic examination is often confounded by pain, sedation, mechanical ventilation, and distracting injuries, so regular sedation pauses for examination and maintaining a high index of suspicion for neurologic complications are warranted. Expand
Physiopathology of Intraoperative Visceral Ischemia and Anesthesiological Management of Supravisceral Aortic Clamping
TLDR
The interruption of the blood flow to the organs, secondary to the artic cross-clamp, triggers cellular and molecular alterations with local and systemic effects which may trigger postoperative multi-organ failure. Expand
Acute non-traumatic disease of the abdominal aorta
TLDR
The goal of treating acute aortic pathology is to repair and prevent rupture, as well as restore and maintain perfusion of the lower extremities, kidneys, and mesentery, but both open and endovascular repair of the abdominal aorta may become acutely complicated, resulting in compromise of these goals. Expand
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References

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Prevention and detection of spinal cord injury during thoracic and thoracoabdominal aortic repairs.
TLDR
Maintaining spinal cord perfusion pressure at more than 40 mm Hg by increasing mean distal aortic pressure or withdrawal of cerebrospinal fluid is valuable for preventing paraplegia. Expand
Low incidence of paraplegia after thoracic endovascular aneurysm repair with proactive spinal cord protective protocols.
TLDR
Proactive spinal cord protective protocols appear to reduce the incidence of spinal ischemia after TEVAR compared with historical series, and it is suggested that active, as opposed to reactive, approaches to spinal ischeia portend a better long-term outcome. Expand
Spinal cord protection in descending thoracic and thoracoabdominal aortic repair.
TLDR
With the surgical adjuncts of cerebrospinal fluid drainage and distal aortic perfusion, the probability of neurologic deficit is lowered appreciably. Expand
Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms.
TLDR
Endovascular repair of TAA has shown a promising reduction in operative morbidity; however, the risk of spinal cord ischemia remains and spinal cord protective measures should be used for patients with the aforementioned risk factors undergoing endovascular TAA repair. Expand
Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair.
TLDR
The extent of SA sacrifice is the most powerful predictor of paraplegia risk for aneurysms of moderate extent and more distal location involving the abdominal aorta increases the risk of spinal cord injury. Expand
Assessment of spinal cord integrity during thoracoabdominal aortic aneurysm repair.
TLDR
In patients with TAAA, blood supply to the spinal cord depends upon a highly variable collateral system, and monitoring MEPs is an accurate technique for detecting cord ischemia, guiding surgical tactics to reduce neurologic deficit. Expand
Protection of the spinal cord during surgery of thoraco-abdominal aortic aneurysms.
  • J. Bachet, D. Guilmet, +7 authors P. de Lentdecker
  • Medicine
  • European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
  • 1996
TLDR
The preoperative study of the medullar vascularization and the use of extracorporeal circulation with deep hypothermia and sequential aortic unclamping, reduce the risk of severe cord ischemia and Occurrence of postoperative paraplegia depends on several factors and cannot be totally prevented by the surgical technique. Expand
The incidence of spinal cord ischaemia following thoracic and thoracoabdominal aortic endovascular intervention.
  • S. Drinkwater, A. Goebells, +4 authors R. Gibbs
  • Medicine, Mathematics
  • European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
  • 2010
TLDR
SCI following thoracic and thoracoabdominal aortic endovascular intervention is associated with the proportion of aorta covered, which varies between different types of procedure and this should be carefully considered in both selection and consenting of patients. Expand
Spinal cord ischemia after endovascular aortic repair versus open surgical repair for descending thoracic and thoracoabdominal aortic aneurism
TLDR
The incidence of SCI was similar in the OSR and TEVAR groups, but delayed SCI occurred more frequently in theTEVAR group, and SCI showed a similar course of recovery in the two groups. Expand
Neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair.
TLDR
The combined adjuncts of distal aortic perfusion and cerebrospinal fluid drainage demonstrated improved neurologic outcome with repair of thoracic and TAAAs and continue to make a considerable difference in the outcome and to provide significant protection against spinal cord morbidity in extent II aneurysms. Expand
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