Protection of the spinal cord during surgery of thoraco-abdominal aortic aneurysms

Abstract

In our experience: 1) The risk of paraplegia is related to the extension and the type of the aortic lesions. 2) The preoperative study of the medullar vascularization and the use of extracorporeal circulation with deep hypothermia and sequential aortic unclamping, reduce the risk of severe cord ischemia, and 3) Occurrence of postoperative paraplegia depends on several factors and cannot be totally prevented by the surgical technique.

Penetrating atherosclerotic ulcer of the descending thoracic aorta: Treatment by endovascular stent-Graft

“…Moreover, surgical repair of the descending thoracic aorta is frequently complicated by respiratory disease, renal insufficiency or spinal ischemia (in 20%, 14%, and 9% of cases respectively) [6][7][8][9][10]. The early surgical mortality rate ranges from 9% to 38% [6][7][8][9][10][11][12] and is probably underestimated for elderly and atherosclerotic patients with a penetrating aortic ulcer.…”

Deep hypothermic circulatory arrest for thoracoabdominal aortic aneurysm repair in a patient with a large intracranial anterior communicating artery aneurysm

“…Deep hypothermic circulatory arrest was used to repair the thoracoabdominal aorta. Deep hypothermic circulatory arrest may be used safely and effectively in both ICA [8][9][10] and TAAA surgery [10,11]. Using deep hypothermic circulatory arrest during thoracic aortic repair has several advantages over other distal perfusion methods, although it may result in neuropsychological complications, coagulopathy, renal failure, and pulmonary dysfunction [10].…”

Endovascular surgery for failed open aortic aneurysm repair*1

“…Because of the sometimes quite important adhesions formed after a previous surgical procedure, re-operations of the aorta taking the open route are often more demanding than primary surgical procedures. As a matter of fact emergency and redo-operations were the only significant risk factors for mortality in study on 115 patients who underwent open descending thoracic and thoraco-abdominal aneurysm repair [11]. In addition, lack of collaterals due to previous surgical dissection has been suggested as one factor enhancing the risk of parapareses and paraplegias during redo descending thoracic and thoraco-abdominal aortic surgery.…”