Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: Results of a randomized clinical trial

Coselli, Joseph S.; LeMaire, Scott A.; Köksoy, Cüneyt; Schmittling, Zachary C.; Curling, Patrick E.

doi:10.1067/mva.2002.122024

Cited by 645 publications

(379 citation statements)

References 32 publications

Supporting

Mentioning

363

Contrasting

Unclassified

Order By: Relevance

“…However, TAAA open surgical or endovascular aneurysm repair (EVAR) is major extensive surgery and carries a significant risk of mortality and post-operative complications of which the most feared and devastating is that of paraplegia. This is a direct consequence of the restriction of spinal cord blood flow during surgical repair and consequently causes spinal cord ischaemia (SCI) [5]. Published rates of spinal cord ischaemia are varied worldwide can have been reported as high as 30% [6][7][8][9][10] .…”

mentioning

confidence: 99%

A Novel Microwave Sensor to Detect Specific Biomarkers in Human Cerebrospinal Fluid and Their Relationship to Cellular Ischemia During Thoracoabdominal Aortic Aneurysm Repair

et al. 2015

View full text Add to dashboard Cite

mentioning

confidence: 99%

A Novel Microwave Sensor to Detect Specific Biomarkers in Human Cerebrospinal Fluid and Their Relationship to Cellular Ischemia During Thoracoabdominal Aortic Aneurysm Repair

et al. 2015

View full text Add to dashboard Cite

“…Spinal catheter drainage as suggested by Hollier 9 , has now been shown to reduce the incidence of paraplegia in some large clinical series. 2,3 Reduction of intra-spinal pressure is intended to improve blood flow at any given perfusion pressure. Reimplantation of intercostal arteries is also an effort to maintain circulation to the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

“…Reports from centers with a large experience with DT and TAA aneurysm repair have documented improved results when distal aortic perfusion and spinal catheter drainage are used. [1][2][3][4] These adjuncts attempt to address issues of organ dysfunction secondary to hypoperfusion. Additional maneuvers have been suggested which may help reduce the risk of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair: 15-Year Results Using a Uniform Approach

Quiñones-Baldrich

2004

Annals of Vascular Surgery

View full text Add to dashboard Cite

Objective: This review presents the results of surgical repair of descending thoracic (DT) and thoracoabdominal (TAA) aortic aneurysms, using spinal drainage, distal aortic perfusion, and other adjuncts intended to reduce complications. and 2002. Mortality was 2/36 (5.5%) in the elective group. In the emergency group, there were 2 intraoperative deaths and mortality was 4/14 (28.5%, p<.07). Overall survivor morbidity was 6/34 (17.6%) in elective and 7/10 (70%, p<.02) in emergency cases. Paraplegia occurred in one patient in the elective group (2.7%) with dissecting type II TAA aneurysm in whom the intercostal patch was sacrificed. Two of 12 initial survivors developed paraplegia in the emergency group (16.7%); one had SD but neither had DAP or intercostal reimplantation. Serious complications were associated with avoidable deviations from the approach. Five and 10 year survival for the entire series was 64.8% and 46.4%, respectively. Methods Conclusions:These results parallel those in contemporary reports from centers where repair of descending and thoracoabdominal aortic aneurysm is frequently performed. Good long-term results can be achieved using spinal drainage and distal aortic perfusion, combined with other adjuncts as a means of reducing complications.When possible, the same approach should be used in emergency cases.

show abstract

“…Cerebrospinal fluid drainage is often used as an adjunct for spinal cord protection following thoracoabdominal aortic aneurysm repair. Coselli et al 12 showed in a randomized control trial with and without CSF drainage following thoracoabdominal aortic aneurysm that 2.6% of patients developed neurologic deficits/ paraplegia with CSF drainage versus 13% of patients treated without CSF drainage.…”

Section: Treatment Options After An Intraoperative Scimentioning

confidence: 99%

Prevention, identification, and treatment of perioperative spinal cord injury

Ahn¹,

Fehlings

2008

FOC

View full text Add to dashboard Cite

Object In this report, the authors suggest evidence-based approaches to minimize the chance of perioperative spinal cord injury (POSCI) and optimize outcome in the event of a POSCI. Methods A systematic review of the basic science and clinical literature is presented. Results Authors of clinical studies have assessed intraoperative monitoring to minimize the chance of POSCI. Furthermore, preoperative factors and intraoperative issues that place patients at increased risk of POSCI have been identified, including developmental stenosis, ankylosing spondylitis, preexisting myelopathy, and severe deformity with spinal cord compromise. However, no studies have assessed methods to optimize outcomes specifically after POSCIs. There are a number of studies focussed on the pathophysiology of SCI and the minimization of secondary damage. These basic science and clinical studies are reviewed, and treatment options outlined in this article. Conclusions There are a number of treatment options, including maintenance of mean arterial blood pressure > 80 mm Hg, starting methylprednisolone treatment preoperatively, and multimodality monitoring to help prevent POSCI occurrence, minimize secondary damage, and potentially improve the clinical outcome of after a POSCI. Further prospective cohort studies are needed to delineate incidence rate, current practice patterns for preventing injury and minimizing the clinical consequences of POSCI, factors that may increase the risk of POSCI, and determinants of clinical outcome in the event of a POSCI.

show abstract

Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: Results of a randomized clinical trial

Abstract: Perioperative CSFD reduces the rate of paraplegia after repair of extent I and II TAAAs.

Cited by 645 publications

References 32 publications

A Novel Microwave Sensor to Detect Specific Biomarkers in Human Cerebrospinal Fluid and Their Relationship to Cellular Ischemia During Thoracoabdominal Aortic Aneurysm Repair

A Novel Microwave Sensor to Detect Specific Biomarkers in Human Cerebrospinal Fluid and Their Relationship to Cellular Ischemia During Thoracoabdominal Aortic Aneurysm Repair

Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair: 15-Year Results Using a Uniform Approach

Prevention, identification, and treatment of perioperative spinal cord injury

Contact Info

Product

Resources

About