Improved outcome after repair of descending and thoracoabdominal aortic aneurysms using modern adjuncts

Khoynezhad, Ali; Bello, Ricardo; Smego, Douglas; Nwakanma, Lois U.; Plestis, Konstadinos A.

doi:10.1510/icvts.2005.114470

Cited by 22 publications

(11 citation statements)

References 9 publications

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“…Paraplegia remains the most devastating complication after repair of extensive descending thoracic aneurysms (DTA) and thoracoabdominal aortic aneurysms (TAAA). 1 The maintenance of adequate spinal cord oxygenation is critical to the success of open and endovascular repair of TAAAs to prevent spinal cord ischemia when blood flow to the spinal cord is impaired (e.g., by segmental artery occlusion or aortic cross-clamping). Monitoring of spinal cord function using motor evoked potentials (MEP) or somatosensory evoked potentials (SSEP) is widely accepted in the assessment of intraoperative spinal cord viability during aortic procedures, but it requires significant technical effort and invasiveness.…”

Section: Introductionmentioning

confidence: 99%

Near-infrared Spectroscopy Monitoring of the Collateral Network Prior to, During, and After Thoracoabdominal Aortic Repair: A Pilot Study

Etz

Aspern

Gudehus

et al. 2013

European Journal of Vascular and Endovascular Surgery

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Section: Introductionmentioning

confidence: 99%

Near-infrared Spectroscopy Monitoring of the Collateral Network Prior to, During, and After Thoracoabdominal Aortic Repair: A Pilot Study

Etz

Aspern

Gudehus

et al. 2013

European Journal of Vascular and Endovascular Surgery

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“…In the pioneering experience of Svensson et al [9], operative morbidity and mortality were high. However, operative results have been improving because of innovations such as perioperative cerebrospinal fluid drainage, distal aortic perfusion, reattachment of critical intercostal arteries, permissive hypothermia, and hypothermic circulatory arrest [6,7,10,11]. The in-hospital mortality rate is now 4-10%, and paraplegia or paraparesis occurs in only 2.4-4.5% of patients [6,7,10,11].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection☆

Miyamoto

Ohata

Mitsuno

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: To examine the long-term outcomes after entry closure and aneurysmal wall plication for type B chronic dissecting aortic aneurysm. This procedure uses no artificial graft and preserves all intercostal arteries. Methods: We reviewed the records of 40 consecutive patients who underwent this procedure between September 1983 and December 2002. The mean age at operation was 60 AE 12 years (range, 38-79 years). The mean follow-up period was 9.8 AE 5.1 years (range, 4-23 years). Follow-up was completed in 38 patients (95%). The latest computed tomography scans (n = 22) were obtained 9.5 AE 5.1 years (range, 3-18 years) after surgery. Results: There were no operative deaths and 14 late deaths, none of which were related to the aneurysm. No paraplegia or paraparesis occurred. The survival rate was 92 AE 4% at 5 years and 64 AE 9% at 10 years; 24 patients are still alive. Follow-up computed tomography revealed that the mean diameter of the plicated descending aorta was 31 AE 5 mm (range, 22-39 mm) except in four patients. One of the four patients required reoperation for recurrent aneurysm of the plicated aorta 3 years postoperatively. In the remaining three patients, the plicated aorta has become enlarged; however, these patients have not yet undergone reoperation. Reoperation for residual dissecting aneurysm was performed in another three patients whose plicated aorta was normal. Freedom from reoperation for residual dissecting aneurysm was 78 AE 5% at 10 years. Conclusions: This procedure produces excellent short-term outcomes and low long-term morbidity. It could be the procedure of choice in selected patients to prevent paraplegia, although graft replacement is currently the standard treatment for chronic aortic dissecting aneurysm. #

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“…At this portion of the TEVAR procedure, the blood pressure is increased, the cardiac output is increased, and (on occasion) the hemoglobin concentration is increased to improve blood oxygen delivery to spinal cord. Typically, the patient is allowed briefly to recover from the antihypertensive treatment modalities, aiming for mean blood pressure in 80s to 90s mmHg to reduce the spinal cord ischemia [33]. Increased blood pressure improves the spinal cord perfusion pressure in the anterior spinal artery across the stent-grafted segment of the aorta that now has lack of perfusion from the intercostal arteries [4,13].…”

Section: Periprocedural Hemodynamic Managementmentioning

confidence: 99%

Perioperative Hemodynamic Management and Pharmacotherapeutics of Patients Undergoing Thoracic Endovascular Aortic Repair

Muehle

Uzun

Jalali

et al. 2014

Advances in Vascular Medicine

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Thoracic endovascular aortic repair (TEVAR) has become an attractive alternative treatment option for many patients with specific thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications and improve neurological outcomes. Hemodynamic management of these patients is a critical aspect in reducing neurological deficit and it is different compared to patients undergoing open thoracic aortic operations. There are two different phases of blood pressure management for patients with thoracic aortic disease. Before and during the critical steps of TEVAR anti-impulsive therapy facilitates safe positioning and stent deployment. After stent grafts are deployed, controlled hypertensive blood pressure levels are achieved to avoid spinal cord ischemia. This precise blood pressure strategy is essential to ensure a safe procedure and good long-term results.

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Improved outcome after repair of descending and thoracoabdominal aortic aneurysms using modern adjuncts

Abstract: Use of perioperative cerebrospinal fluid drainage, distal aortic perfusion and permissive hypothermia result in a low incidence of spinal cord injury and a low operative mortality.

Cited by 22 publications

References 9 publications

Near-infrared Spectroscopy Monitoring of the Collateral Network Prior to, During, and After Thoracoabdominal Aortic Repair: A Pilot Study

Near-infrared Spectroscopy Monitoring of the Collateral Network Prior to, During, and After Thoracoabdominal Aortic Repair: A Pilot Study

Long-term outcomes after entry closure and aneurysmal wall plication for type B aortic dissection☆

Perioperative Hemodynamic Management and Pharmacotherapeutics of Patients Undergoing Thoracic Endovascular Aortic Repair

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