Fighting spinal cord complication during surgery for thoracoabdominal aortic disease
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Yutaka Okita, MD, PhD
- چاپ و سال / کشور: 2008
Description
Paraplegia or paraparesis after otherwise successful thoracic or thoracoabdominal aortic reconstruction is a devastating complication for both patient and physician. Various strategies have been developed to minimize the incidence of neurological complications after aortic surgery. The incidence of spinal cord ischemia and subsequent neurological complications has been correlated with (1) the duration and severity of ischemia, (2) failure to establish a spinal cord blood supply, and (3) reperfusion injury. Preoperative identifi cation of the arteria radicularis magna, the artery of Adamkiewicz, facilitates identifi cation of critical intercostal vessels for reimplantation, resulting in reestablishing spinal cord blood fl ow. Techniques for monitoring spinal cord function using evoked potentials have been developed, and surgical techniques have evolved to reduce the duration of ischemia. Furthermore, sequentially sacrifi cing all the intercostal arteries while maintaining collateral circulation to the cord has produced good outcomes. The severity of ischemia can be minimized by using cerebrospinal fl uid drainage, hypothermia, distal bypass, managing the blood pressure, and adjunctive pharmacological therapy. Reperfusion injury can be reduced with the use of antioxidant therapy. Recent advances in endovascular stentgrafting have reduced the incidence of postoperative spinal complications, especially among high-risk patients
Gen Thorac Cardiovasc Surg (2011) 59:79–90 DOI 10.1007/s11748-010-0668-x Received: 6 November 2008
