Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair

Kawanishi, Yujiro; Okada, Kenji; Matsumori, Masamichi; Tanaka, Hiroshi; Yamashita, Teruo; Nakagiri, Keitaro; Okita, Yutaka

doi:10.1016/j.athoracsur.2007.02.089

Cited by 37 publications

(26 citation statements)

References 18 publications

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“…19,[32][33][34]51,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] Only the most recent publication or that containing the largest patient cohort was selected when several publications originated from the same institution.…”

Section: Overview Of the Results Of Recently Published Seriesmentioning

confidence: 99%

“…Maintaining hemodynamics is considered of vital importance for spinal cord protection during thoracoabdominal aortic surgery not only in the operating room but also in the intensive care unit. 51 Aggressive correction of anemia and hypovolemia and the prevention of coagulopathy improve tissue oxygen delivery. Surgeons should consider that many patients who develop delayed paraplegia have a documented period of cardiovascular instability before symptoms develop.…”

Section: Mild Hypothermiamentioning

confidence: 99%

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Current strategies for spinal cord protection during thoracic and thoracoabdominal aortic aneurysm repair

Shimizu

Yozu

2011

Gen Thorac Cardiovasc Surg

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Surgery for thoracoabdominal aortic aneurysms remains challenging, with high mortality and morbidity rates despite overall improvements in the outcome of aortic surgery. Paraplegia and paraparesis remain devastating complications that severely restrict the chance of survival as well as the postoperative quality of life. Preventive measures vary considerably because the causes of spinal cord insufficiency are multifactorial. Here, we review measures to prevent paraplegia/paraparesis arising after surgery for thoracic and thoracoabdominal aortic aneurysms.

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Section: Overview Of the Results Of Recently Published Seriesmentioning

confidence: 99%

Section: Mild Hypothermiamentioning

confidence: 99%

Current strategies for spinal cord protection during thoracic and thoracoabdominal aortic aneurysm repair

Shimizu

Yozu

2011

Gen Thorac Cardiovasc Surg

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“…Kawanishi et al 69 reported that systemic hypotension had a major role leading to spinal cord ischemia not only during the bypass but also during the postoperative period even in the intensive care unit. Porcine experimental studies disclosed that numerous blood network systems were present around the spinal cord, including major collateral pathways from the left subclavian artery, intercostal artery, lumbar artery, and hypogastric arteries.…”

Section: Effect Of Systemic Blood Pressure On Spinal Perfusionmentioning

confidence: 98%

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

Okita

2011

Gen Thorac Cardiovasc Surg

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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 identification of the arteria radicularis magna, the artery of Adamkiewicz, facilitates identification of critical intercostal vessels for reimplantation, resulting in reestablishing spinal cord blood flow. 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 sacrificing 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 fluid 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.

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“…Blodet føres tilbake til pasienten via a. femoralis i lysken. Det tilstrebes et distalt arterietrykk på minst 60 mm Hg, noe avhengig av pasientens preoperative trykk (18). I denne fasen av operasjonen perfunderes kroppens proksimale deler fra hjertet mens distale deler forsynes fra sentrifugalpumpen (fig 3).…”

Section: Det Operative Inngrepetunclassified

Torakoabdominale aortaaneurismer – åpen kirurgi og endovaskulær behandling

Myhre¹,

Ødegård²,

Winnerkvist³

et al. 2009

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Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair

Cited by 37 publications

References 18 publications

Current strategies for spinal cord protection during thoracic and thoracoabdominal aortic aneurysm repair

Current strategies for spinal cord protection during thoracic and thoracoabdominal aortic aneurysm repair

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

Torakoabdominale aortaaneurismer – åpen kirurgi og endovaskulær behandling

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