Perioperative Management to Improve Neurologic Outcome in Thoracic or Thoracoabdominal Aortic Stent-Grafting

Incidence of neurological complications following overstenting of the left subclavian artery

“…When alterations of evoked potentials occurred, we initiated spinal-cord protection efforts. These protection methods have been described in detail [11,12]. In all other 14 patients measured, tcMEP potentials were consistent at the end of the operation.…”

“…Intraoperative neurophysiological monitoring with transcranial motorevoked potentials (tcMEP) and somatosensory-evoked potentials (SSEP), as well as cerebrospinal fluid (CSF) pressure monitoring was applied in 17 (elective = 5, urgent = 7, emergent = 5) patients as a control mechanism to identify spinal cord ischemia during ESI (Table 3). This technique has been described in detail previously [11,12]. Whenever CSF pressure exceeded 15 mmHg, CSF drainage was carried out.…”

Late Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repairs

“…In the 17 years since the initial report of this therapy by Dake et al, 21 there has been a paucity of good scientific evidence to support a consensus on this issue, in large part because of insufficient center-specific clinical volume and heterogeneity of anatomies and pathologies. Although multiple risk factors have been reported, including length of aortic coverage, 22 prior abdominal aortic aneurysm repair, 23 hypotension, 24 renal failure, 25 and LSA coverage, 26 the occurrence of SCI has been relatively infrequent even in the presence of some or all of these factors. Our policy of prophylactic drainage focused mainly on the extent of aortic coverage because this was one parameter that seemed most reasonable and predictable.…”

Transient Unilateral Lower Limb Palsy after Open Surgery Thoraco-Abdominal Aorta Repair

“…Spinal Cord Ischemia (SCI) may be due to hemodynamic impairment and/or to segmental artery occlusion during aortic clamping [1,2].…”

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AbstractParaplegia is one of the most devastating complication after Thoraco-abdominal Aorta (TAA) repair both in open surgery and in endovascular procedure, caused by critical obstruction to blood perfusion of the Spinal Cord.Spinal Cord Ischemia (SCI) may be due to hemodynamic impairment and/or to segmental artery occlusion during aortic clamping [1,2].We report a case of chronically dissected Thoraco-abdominal Aortic Aneurysm (TAAA) which showed unilateral transient neurological impairment of the left lower limb, postoperatively.

KeywordsSpinal cord injury, Aorta, Surgery chronic obstructive pulmonary disease (COPD) with FEV1/FVC ratio 0.43 and FEV1 1.12 L (44%).The pre-operative echocardiogram showed: Mild hypertrophy of left ventricle walls (13-14 mm), left ventricle end-diastolic volume at upper limit (LVEDVi = 74 ml/ m 2 ), inferior wall and interventricular septum were akinetic providing a reduced ejection fraction (LVEF 0.38) that did ameliorate at dobutamine echo-stress (LVEF 0.47); furthermore it showed mild aortic valve stenosis (medium pressure gradient 20 mmHg with valve area 1.2 cm 2 ).He underwent general anesthesia that was inducted by Midazolam 5 mg iv, Fentanyl 200 mcg iv. After myorelaxation with cis-Atracurium 12 mg iv a double-lumen endotracheal tube n.41 was inserted to connect the patient's airways to mechanical ventilator (Vt 560; respiratory rate 12; positive end-expiratory pressure 5 cm H 2 O); he received a gas mixture of oxygen/air (FiO 2 40-60%) and Sevoflurane 1-2%, as appropriate.

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