Perioperative Stroke and Paraplegia in Descending Thoracic Aortic Stent Grafting

Schurink, Geert-Willem; Haan, Michiel de; Jacobs, Michael

doi:10.1002/9780470760314.ch4

Cited by 2 publications

(4 citation statements)

References 49 publications

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“…To reduce the risk of neurologic complications, a number of ancillary techniques have been developed and used (Table IV). [21][22][23][24][25][26][27][28][29][30] No method has been ultimately successful in the prevention of paraplegia, however.…”

Section: Discussionmentioning

confidence: 99%

“…The use of somatosensory evoked potential has also been advocated to achieve this goal. 28 The reported strategies include somatosensory evoked potential monitoring during a 20-minute deployment of a retrievable stent graft 41 or during a 15-minute segmental balloon occlusion of the aorta, with or without an external axillofemoral bypass. 42 The occurrence of ischemic changes during these tests may jeopardize the completion of the procedure, however, and the risk of embolization remains considerable.…”

Section: Discussionmentioning

confidence: 99%

“…•steroids 24 •naloxone hydrochloride 25 •barbiturates 26 •papaverine hydrochloride 27 Spinal cord monitoring 28 "Clamp-and-sew" technique 29 Cerebrospinal fluid drainage 30 plegia, prompt CSF drainage, if not previously instituted, is also used to keep the CSF pressure Ͻ10 mm Hg and possibly reverse the deficit. Such drainage is maintained for 72 hours after open repair, as previously suggested.…”

Section: Table IV Ancillary Techniques For Prevention Of Spinal Cord Ischemia During Thoracic Aortic Repairmentioning

confidence: 99%

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Spinal cord ischemia after elective stent-graft repair of the thoracic aorta

Chiesa

Melissano

Marrocco-Trischitta

et al. 2005

Journal of Vascular Surgery

257

160

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Perioperative hypotension (MAP <70 mm Hg) was found to be a significant predictor of spinal cord ischemia; hence, careful monitoring and prompt correction of arterial pressure may prevent the development of paraplegia. When the latter occurred, reduction of the CSF pressure by drainage was useful. Patients with a previous or synchronous abdominal aortic repair may also benefit from CSF drainage as a perioperative adjunct.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Table IV Ancillary Techniques For Prevention Of Spinal Cord Ischemia During Thoracic Aortic Repairmentioning

confidence: 99%

See 1 more Smart Citation

Spinal cord ischemia after elective stent-graft repair of the thoracic aorta

Chiesa

Melissano

Marrocco-Trischitta

et al. 2005

Journal of Vascular Surgery

257

160

View full text Add to dashboard Cite

show abstract

“…Other techniques, such as distal aortic perfusion and various pharmacologic interventions, have not been known to reduce the incidence. Various means of identifying patients at risk of spinal cord ischemia, including somatosensory evoked potentials during temporary occlusion of the involved aortic segment, 33,34 can be used but are not without risks and are not routinely recommended.…”

Section: Discussionmentioning

confidence: 99%

Stent Grafts for Thoracic Aortic Pathology: Single-Center Experience in Western Australia

et al. 2005

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The purpose of this article is to report a single-center experience in treating thoracic aortic pathology with stent grafts. This is a retrospective review of cases done within a period of 30 months. Between January 2002 and May 2004, 12 patients were treated in our institution with thoracic stent grafts (n = 12) for various clinical conditions. There were seven men and five women. Three patients required emergency treatment (n = 3), two for aortic transection and one for iatrogenic injury during lung biopsy. Others were treated electively (n = 9). All patients were high risk for open surgery. There was one perioperative death, with a patient with multiple trauma succumbing to head injury 4 weeks after stent graft insertion. There was no incidence of paraplegia. Three patients underwent bypass surgery in the neck to achieve an adequate proximal seal zone prior to stent grafting. One patient with an aneurysm of the descending thoracic aorta required an extension limb below the original graft for an increase in sac size, possibly owing to endotension. Renal failure occurred in one patient and resolved without dialysis. One patient died 18 months after her procedure, possibly owing to aneurysm expansion. Stent grafts are a viable alternative to open surgery for thoracic aortic pathology in high-risk individuals. Visceral and spinal cord ischemia is less prevalent with stent grafts compared with open surgery. The short-term results are promising. Long-term follow-up is awaited. Stent grafts might have greater impact in the thoracic aorta than the abdominal aorta for which they were initially developed.

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Perioperative Stroke and Paraplegia in Descending Thoracic Aortic Stent Grafting

Cited by 2 publications

References 49 publications

Spinal cord ischemia after elective stent-graft repair of the thoracic aorta

Spinal cord ischemia after elective stent-graft repair of the thoracic aorta

Stent Grafts for Thoracic Aortic Pathology: Single-Center Experience in Western Australia

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