Near-infrared spectroscopy monitoring of the collateral network to detect spinal cord malperfusion during and after thoracoabdominal aortic repair: A clinical update

Etz, CD; Aspern, Konstantin von; Gudehus, S.; Luehr, Maximilian; Banusch, J.; Ender, J.; Borger, M.A.; Misfeld, Martín; Mohr, FW

doi:10.1055/s-0034-1367211

Cited by 9 publications

(9 citation statements)

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“…In a recent review, Uchida 10 showed an average SCI rate of 4.5% (range, 0%-10.3 %) in 7309 TEVAR patients, suggesting that endoluminal procedures are not superior to the open approach, especially compared with the rate at aortic centers performing a high volume of open repairs. 9 , 12 , 13 , 14 Endoluminal approaches avoid aortic cross-clamping and most of the intraoperative hemodynamic changes but prevent reimplantation of the intercostal arteries covered by the stent graft.…”

Section: Discussionmentioning

confidence: 99%

The fate of spinal arteries after the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair technique: A case series

Lopes

Melo

Leitão

et al. 2023

Journal of Vascular Surgery Cases, Innovations and Techniques

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Section: Discussionmentioning

confidence: 99%

The fate of spinal arteries after the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair technique: A case series

Lopes

Melo

Leitão

et al. 2023

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…The incidence of SCI after TEVAR is not significantly lower than that after open thoracoabdominal aortic aneurysm repair. [25] However, delayed paralysis/paralysis is the primary manifestation of SCI after TEVAR, as compared with open abdominal surgery. [26] While the pathogenesis of SCI after TEVAR is multifactorial and not fully understood, 2 theories regarding the mechanism of SCI have been suggested: the first relates to inadequate remodeling of the collateral blood network to maintain spinal cord viability, whereas the second refers to atheroembolisation of aortic plaque material into the segmental arteries supplying the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Two-stage aortic surgery for distal aortic arch and descending aorta aneurysms: A case report

et al. 2022

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Rationale: Although surgical treatment strategies for patients with extensive thoracic aortic disease involving the aortic arch have improved considerably, the impact of stent graft length and placement site on aortic remodeling at long-term follow-up is not fully understood, and the protection of the Adamkiewicz artery (AKA) using the frozen elephant trunk (FET) method is also unclear.Patient concerns: The patient was a 69-year-old man with diabetic nephropathy who became increasingly fatigued and started maintenance hemodialysis 6 months prior to admission. At 64 years, he underwent clipping of a right cerebellar artery aneurysm. In addition, a 1.8 cm aneurysm was found in the contralateral extracranial internal carotid artery. He also had an atrial septal defect and moderate aortic regurgitation and was receiving continuous positive airway pressure therapy for sleep apnoea syndrome.Diagnosis: He had aneurysms in the aortic arch (4.8 cm in diameter) and descending aorta (6 cm in diameter), which was located at T6-9. Preoperative 3-dimensional computed tomography showed that the (AKA) bifurcated at T10-11.Interventions: Considering the patient's several comorbidities and frailty, we planned to perform 1-stage extended aortic arch repair using the FET procedure. However, we performed 2-stage aortic surgery to prevent spinal ischemia, anticipating substantial cardiac enlargement and blood pressure instability due to dialysis treatment. Aortic valve replacement, atrial septal defect patch closure, and aortic arch surgery were performed. A 7-cm elephant trunk was inserted in the descending aorta. Postoperatively, the patient continued rehabilitation until his blood pressure stabilized during dialysis therapy. At postoperative week 4, he underwent thoracic endovascular aortic repair for a descending aortic aneurysm.Outcomes: After surgery, his physical strength decreased; however, he recovered and was discharged 1 month later without any complications. One year after the second operation, he is living a healthy life.Lessons: Extensive aortic arch surgery using the FET procedure is effective for distal aortic arch and descending aortic aneurysms. Nevertheless, in cases in which the position of the AKA is close to the aortic aneurysm and blood pressure control is difficult, a 2-stage procedure and accurate positioning of thoracic endovascular aortic repair are both desirable.

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“…However the outcomes with regard to the neurological function did not worsen even after the second TES. There have been several studies which have indicated that occlusion of the segmental 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64arteries leads to the development of collateral pathways of intraspinal and paraspinous arteries and arterioles [13][14][15][16], and these collateral pathways developed within five days after occlusion in those cases. These studies may explain the reasons for the preservation of the neurological function after the multiple-level embolization of the segmental arteries in our case series.…”

Section: Discussionmentioning

confidence: 99%

Repeated total en bloc spondylectomy for spinal metastases at different sites in one patient

et al. 2015

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Title: Repeated total en bloc spondylectomy for spinal metastases at different sites in one patient. Keywords:spinal metastases; total en bloc spondylectomy; preoperative artery embolization; nerve root ligation and cut; repeated times Abstract Purpose: Total en bloc spondylectomy (TES) is accompanied by preoperative embolization of segmental arteries, which is limited to three consecutive levels to avoid the risk of spinal cord ischemia. We retrospectively examined the efficacy and safety of repeated TES with embolization of more than three levels of segmental arteries.Methods: Seven patients underwent TES twice for spinal metastases at different levels.Every patient underwent embolization of the bilateral segmental arteries before each surgery. We assessed the total number of segmental arteries embolized, the existence of Adamkiewicz arteries during the embolization procedure, intraoperative blood loss and the motor function of the lower limbs, using the American Spinal Injury Association (ASIA) motor score.

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Near-infrared spectroscopy monitoring of the collateral network to detect spinal cord malperfusion during and after thoracoabdominal aortic repair: A clinical update

Cited by 9 publications

References 0 publications

The fate of spinal arteries after the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair technique: A case series

The fate of spinal arteries after the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair technique: A case series

Two-stage aortic surgery for distal aortic arch and descending aorta aneurysms: A case report

Repeated total en bloc spondylectomy for spinal metastases at different sites in one patient

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