Neurologic Outcomes from High Risk Descending Thoracic and Thoracoabdominal Aortic Operations in the Era of Endovascular Repair

Abstract

Ischemic neurologic complications were frequent and strongly associated with poor outcomes after open DTA and TAA repair among patients not eligible for TEVAR. Risk of death or neurologic disability can be estimated based on factors known prior to surgery.

Heat shock proteins as biomarkers for the rapid detection of brain and spinal cord ischemia: a review and comparison to other methods of detection in thoracic aneurysm repair

“…But spinal cord ischemia remains an important complication of TEVAR as well, occurring in up to 12% of patients (Lewis et al 2002;Sullivan and Sundt 2006;Nienaber et al 2009). We found that patients who are paraplegic upon awakening from surgery remain paralyzed and have greater than 65% mortality (Messe et al 2008). Biomarkers for the real-time detection of ongoing spinal cord ischemia or prediction of an increased risk for paralysis would potentially provide time to intervene and would be of great benefit in preventing this devastating complication.…”

Rehabilitation for Spinal Cord Injury Caused by Thoracic Aortic Aneurysm

“…Mortality of AA repair (SCI) 39% 14% Table 2. Mortality of aortic aneurysm repair complicated with central nervous system ( Messe et al, 2008) …”

When Is Hypertension a True Crisis and How Should It Be Managed in the Intensive Care Unit?

“…Although data derived from randomized controlled trials are lacking, some experts believe that spinal cord ischemia may be relieved by improving spinal perfusion with systemic hypertension (mean arterial pressure, 80 to 100 mm Hg) and titrated drainage of cerebrospinal fluid. 39,40 In this scenario, many practitioners believe that relative systemic hypertension is essential to prevent spinal cord ischemia. This takes priority over the threat of bleeding from aortic suture lines.…”