Prevention of paraplegia in transluminally placed endoluminal prosthetic grafts for descending thoracic aortic aneurysms

Midorikawa, Hirofumi; Hoshino, Shunichi; Iwaya, F; Igari, Tsuguo; Satou, Kouichi; Ishikawa, Kazunori

doi:10.1007/bf03218249

Cited by 11 publications

(4 citation statements)

References 23 publications

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“…The first report involved a 15-minute balloon occlusion of the aortic segment to be excluded and the second strategy used a retrievable stent graft deployed to exclude the aneurysm for 20 minutes. 19,20 Significant evoked potential change might preclude the ability to deploy the final endograft. The risks associated with both of these procedures include additional instrumentation of a diseased aorta with resulting atheroembolization.…”

Section: A B Cmentioning

confidence: 99%

Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms

Gravereaux

Faries

Burks

et al. 2001

Journal of Vascular Surgery

285

190

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Endovascular repair of TAA has shown a promising reduction in operative morbidity; however, the risk of spinal cord ischemia remains. Concomitant or previous abdominal aortic aneurysm repair and long segment thoracic aortic exclusion appear to be important risk factors. Spinal cord protective measures (ie, cerebrospinal fluid drainage, steroids, prevention of hypotension) should be used for patients with the aforementioned risk factors undergoing endovascular TAA repair.

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Section: A B Cmentioning

confidence: 99%

Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms

Gravereaux

Faries

Burks

et al. 2001

Journal of Vascular Surgery

285

190

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“…To what extent CSF drainage will be beneficial to patients treated by endovascular means must be clarified in further studies. Midorikawa et al have proposed preoperative measurement of evoked spinal potential during temporary balloon occlusion for the assessment of the risk for paraplegia prior to stent-graft placement [88]. Noninvasive MR angiography should also be suitable to demonstrate the Adamkiewicz artery preoperatively in patients with TAA or TAAA [89].…”

Section: Resultsmentioning

confidence: 99%

Endovascular treatment of thoracic aortic aneurysms: a review

Thurnher

Grabenwöger

2002

Eur Radiol

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Open surgical repair is considered the traditional treatment for patients with thoracic aortic aneurysms (TAA). In view of the persistent perioperative mobidity and mortality, endovascular stent-graft placement as a minimally invasive and potentially safer treatment for aneurysm of the descending aorta was introduced in 1992. Since then, progress has been made and several institutions have substantiated the safety and effectiveness of stent grafts in the repair of descending TAAs or type-B aortic dissections. Currently, both custom-designed, home-made, and commercially available stent grafts are used. Prior to placement of the endoprosthesis, three major prerequisites must be considered: the localization and morphology of the aneurysm; the distal vascular access of sufficient size; and a limited tortuosity of the abdominal and thoracic aorta. Although short-term results are encouraging, severe complications, including paraplegia, cerebral strokes, and aortic rupture, have been encountered. The long-term durability of currently available stent-graft systems is nonexistent and material fatigue are of major concern to both surgeons and radiologists. Nevertheless, endovascular stent-graft placement could become the procedure of choice in a substantial number of patients with descending TAA.

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“…This is because Adamkiewicz's artery, which commonly exists between Th8 and L2, cannot be reconstructed during stent-graft placement. A temporary balloon occlusion test 16 and retrievable stent graft 17 were developed for the prediction of spinal cord ischemia. Although these methods are effective for preventing paraplegia just after stentgraft placement, they cannot predict delayed onset paraplegia.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Open Abdominal Aortic Replacement and Thoracic Stent-Graft Placement: Report of a Case

et al. 2003

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A 77-year-old man with severe chronic obstructive pulmonary disease was admitted to our hospital for surgical treatment of a proximal descending thoracic aortic aneurysm (dTAA) and an infrarenal abdominal aortic aneurysm (AAA). The patient had poor respiratory function; however, a simultaneous abdominal aortic replacement and thoracic stent-graft placement were successfully performed without any complications. This case report demonstrates that simultaneous abdominal aortic replacement and thoracic stent-graft placement for multiple aneurysms may be feasible and can safely be performed in selected high-risk patients, despite the many problems associated with the treatment of aortic aneurysms using stent grafts.

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Prevention of paraplegia in transluminally placed endoluminal prosthetic grafts for descending thoracic aortic aneurysms

Abstract: It is suggested that the preoperative measurement of evoked spinal potential during temporary balloon occlusion is clinically useful for the assessment of the risk to paraplegia occurring in transluminally placed endoluminal prosthetic grafts.

Cited by 11 publications

References 23 publications

Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms

Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms

Endovascular treatment of thoracic aortic aneurysms: a review

Simultaneous Open Abdominal Aortic Replacement and Thoracic Stent-Graft Placement: Report of a Case

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