Objectives: Endovascular repair of descending thoracic aortic lesions is associated with a substantial risk of perioperative spinal cord ischaemia (SCI) which may lead to permanent paraplegia.We performed a retrospective analysis of our experience in the endovascular treatment of descending thoracic aortic lesions to define the incidence of SCI and to identify factors that contributed to its development.Methods: 67 consecutive patients underwent stent graft repair for descending thoracic aortic lesions including degenerative aneurysm (n ϭ 19), type B dissection (acute n ϭ 2, chronic n ϭ 15), traumatic rupture (acute n ϭ 14, chronic n ϭ 4), penetrating aortic ulcer (n ϭ 5), anastomotic false aneurysm (n ϭ 4), mycotic aneurysm (n ϭ 3) and embolic aortic lesion (n ϭ 1) between June 2000 and June 2005.All procedures were performed with the patient under general anaesthesia and strict blood pressure monitoring. No patient had intra-operative monitoring of spinal evoked potential or cerebrospinal fluid (CSF) drainage to prevent SCI. Neurological evaluation was realized after recovery from general anaesthesia.Fifteen factors, including nature of aortic disease, length of aortic coverage, number of stent-grafts, coverage of the distal third of the thoracic aorta and subclavian artery coverage, were investigated as possible predictors of postoperative SCI.Results: Five patients (7.5%) had postoperative neurological deficits (immediate n ϭ 2, delayed n ϭ 3) referable to SCI. Univariate analysis showed that length of aortic coverage (p Ͻ 0.001) and number of stentgrafts deployed (p ϭ 0.02) were significant predictors of SCI. Multivariate logistic regression analysis showed that length of aortic coverage was the only independent significant predictor of SCI. ROC curve analysis revealed 205 mm of aortic length coverage as the threshold for increased risk of postoperative SCI (p ϭ 0.001), with specificity and sensitivity of 95.2 and 80% respectively.Conclusion: In our study, length of aortic coverage is the only independent predictive factor of SCI after endovascular treatment with 205 mm as a threshold for increased risk. Hence, methods to prevent SCI, especially those aimed at restoration of an adequate spinal cord perfusion pressure, should be offered to patients requiring extensive coverage of the descending thoracic aorta.

ZusammenfassungZwillingsgraviditäten bei der Stute bewirken ökonomische Verluste, da sie im Regelfall zu Aborten, Totgeburten bzw. zur Entwicklung lebensschwacher oder deformierter Fohlen führen. Die transvaginale ultraschallgeleitete Aspiration ist eine effiziente Methode um eine Reduktion zu erreichen. In der vorliegenden Studie wurde bei 27 Zwillingsträchtigkeiten einmalig zwischen dem 21. bis 52. Trächtigkeitstag Fruchtwasser von einem Konzeptus aspiriert. Insgesamt wurde nach 10 bis 14 Tagen eine Überlebensrate der verbleibenden Embryonen von 59,2 % ermittelt. Vierzehn Stuten erhielten eine therapeutische Dosis eines nichtsteroidalen Antiphlogistikums vor sowie 5 Tage nach der Aspiration. Die Überlebensrate in dieser Gruppe betrug 71,4 %. In der unbehandelten Kontrollgruppe betrug sie 46,1 %. Eine direkte Beziehung zwischen der Überlebensrate der verbleibenden Embryonen und dem Trächtigkeitsstadium, in dem die Aspiration vorgenommen wurde, konnte nachgewiesen werden. Eine signifikant geringere Rate wurde nach Aspirationen nach dem 36. Tag beobachtet.Schlüsselwörter: Stute, Zwillingsträchtigkeit, Trächtigkeitstag, Reduktion, Flunixin Transvaginal ultrasound-guided reduction of twin pregnancies in the mareTwin pregnancies in mares cause economic losses as they result in a high rates of abortion, stillbirth or the delivery of dead or weak and deformed foals. Transvaginal ultrasound-guided twin reduction techniques are described for twin pregnancies that advance to the phase of fixation. In total 27 twin pregnancies were ultrasound-guided managed by aspiration of embryonic fluid. Mares with twin pregnancies from day 21 to day 52 were directed to the ultrasound-guided procedure. In total the success rate was 59.3 %. Fourteen mares got a therapeutic dose of Flunixine (Finadyne ® RP; Essex) before and for 5 days after aspiration. The success rate was 71.4 % in the treated group and 46,1 % in the control group. A direct relation between success rate and stage of gestation and aspiration was observed. Success rate of survival of one twin was significantly lower when manipulation was started beyond day 36.

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