Staged Approach Prevents Spinal Cord Injury in Hybrid Surgical-Endovascular Thoracoabdominal Aortic Aneurysm Repair: An Experimental Model

Bischoff, Moritz S.; Scheumann, Johannes; Brenner, Robert; Ladage, Dennis; Bodian, Carol; Kleinman, George; Ellozy, Sharif H.; Luozzo, Gabriele Di; Etz, Christian D.; Griepp, Randall B.

doi:10.1016/j.athoracsur.2011.03.098

Cited by 99 publications

(90 citation statements)

References 28 publications

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“…Повышается опасность спинальных осложнений при эндопротезировании аорты на фоне нестабильной перфу-зии спинного мозга, повреждения его коллатеральной се-ти [3,7,10,12,18,23,31,32,39,43,59,64,71,86]. При стадийном вмешательстве в критический период после протезирования БА, переключения ВВ сохраняется кро-воток по задним межреберным артериям [84].…”

Section: выбор стадийной или одномоментной тактики гибридного вмешатеunclassified

“…При стадийном вмешательстве в критический период после протезирования БА, переключения ВВ сохраняется кро-воток по задним межреберным артериям [84]. Впослед-ствии компенсируется спинальное кровообращение, вос-станавливается перфузионное давление [10], коллате-ральная сеть [70].…”

Section: выбор стадийной или одномоментной тактики гибридного вмешатеunclassified

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Cardiovascular surgeon’s role in hybrid aortic surgery (part 2)

Белов¹,

Каравайкин²,

Belov³

et al. 2016

Kardiol. serdechno-sosud. khir.

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Section: выбор стадийной или одномоментной тактики гибридного вмешатеunclassified

Cardiovascular surgeon’s role in hybrid aortic surgery (part 2)

Белов¹,

Каравайкин²,

Belov³

et al. 2016

Kardiol. serdechno-sosud. khir.

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“…The experiment was embedded in a study on spinal cord injury previously published by our group, 6 which involved a strict 5-day protocol. The entire thoracoabdominal aorta was removed in a necropsy 5 days after stent-graft implantation, and aortic tissue samples were processed for histopathological analysis.…”

Section: Methods Study Designmentioning

confidence: 99%

“…6 Before initiation of the experiments, angiographic measurements of the aortic diameter were conducted in animals of the same weight and size by using a pigtail catheter with radiopaque markers as a reference standard to find the best stent conformation (Table). Due to the specific size and diameter of the descending thoracic aorta (DTA) in this porcine model, the Excluder AAA Endoprosthesis (W.L.…”

Section: Thoracic Stentingmentioning

confidence: 99%

Early Histological Changes in the Porcine Aortic Media After Thoracic Stent-Graft Implantation

Scheumann

Heilmann²,

Beyersdorf³

et al. 2012

Journal of Endovascular Therapy

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¤ ¤Purpose: To describe the histological findings in the aortic wall 5 days after thoracic endovascular aortic repair (TEVAR) in a porcine model. Methods: Two overlapping stent-grafts were implanted in each of 6 juvenile pigs, covering the entire descending thoracic aorta (DTA). On the 5 th postoperative day, tissue samples were taken from the DTA in each animal. Medial thickness and medial necrosis were quantified and compared to measurements from the aortas of 6 control animals. Results: Significant medial thinning was observed in stent-covered regions in the test animals. At the proximal landing zone, aortic wall thickness changed from 1387668 to 782674 mm within the covered aortic segment (p50.028); at the distal landing site, the wall thickness was 365667 mm within the stent and 501657 mm distally (p50.028). In the overlap zone, the aortic wall measured 5246122 vs. 1053677 mm in native controls (p50.004). Aortic thickness proximal to the graft did not differ from the proximal region of native aortas (1468696 vs. 1513680 mm, p50.423), but the aorta was significantly thinner distal to the stent (707638 vs. 815652 mm, p50.004). Laminar necrosis constituted 38%67% of the media in the proximal landing zone, 54%64% in the overlap zone, and 46%613% in the distal landing zone. Conclusion: In this porcine model, significant medial thinning and necrosis of the stented aorta was observed. The findings suggest an early phase of vulnerability of the aortic wall, before scarring and adaptive changes have strengthened the residual aorta.

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“…Paraplegia remains the most devastating complication and is related to the extent of the aorta covered regardless of the repair technique [13]. Experimental animal models and previous observational studies have shown that a staged sacrifice of the spinal arteries (SAs) decreases the risk of paraplegia [14,15]. In an attempt to minimize major morbidity after repair of extensive aortic disease, we have developed a hybrid staged approach for treating these patients.…”

Section: Introductionmentioning

confidence: 99%

Thoracic endovascular repair first for extensive aortic disease: the staged hybrid approach

Vivacqua

Idrees

Johnston

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES: Repair of extensive aortic disease carries a significant risk of death and morbidity, the most feared complication being spinal cord ischaemia. Objectives of this study are to characterize patients, describe repair methods and assess feasibility and safety of hybrid staged repair for treatment of extensive aortic disease. METHODS:From to 2001 to 2013, 22 patients underwent extensive aortic repair that included a thoracic endovascular aortic repair (TEVAR) first followed by an open completion repair extending through the visceral and infrarenal aorta for degenerative aneurysm and dissection. At the time of initial repair, all patients were deemed to be at a high risk for conventional open repair and had extensive disease. Indications for open completion included emergency failure of TEVAR (n = 3), early two-stage approach (n = 6) and delayed disease progression after TEVAR (n = 13). The median interval between stages was 6.5 months. The mean age was 56 ± 14 years, 5 patients had connective tissue disorder and the mean maximum aortic diameter was 58 ± 16 mm preoperatively. RESULTS:There was no death or major complication after initial TEVAR, but the operative mortality rate was 9% (n = 2) after the open procedure. One of these patients died from intraoperative myocardial infarction during emergency repair, and the other had disseminated intravascular coagulation during delayed repair for disease progression after TEVAR. Other complications included paralysis in 1 (4.5%), tracheostomy in 2 (9%) and dialysis in 1 (4.5%), and there was 1 reoperation for bleeding (4.5%). The median follow-up was 37 (range 3.3-93) months and there were no late deaths. There were four late reoperations for proximal disease progression leading to Type 1 endoleak (n = 2), Type A dissection (n = 1) and root aneurysm (n = 1). CONCLUSIONS:Use of a TEVAR-first approach in combination with a staged open repair is a safe and feasible treatment strategy for repair of extensive aortic disease. A staged hybrid approach to aortic repair in patients at high risk for total aortic replacement may limit morbidity.

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Staged Approach Prevents Spinal Cord Injury in Hybrid Surgical-Endovascular Thoracoabdominal Aortic Aneurysm Repair: An Experimental Model

Cited by 99 publications

References 28 publications

Cardiovascular surgeon’s role in hybrid aortic surgery (part 2)

Cardiovascular surgeon’s role in hybrid aortic surgery (part 2)

Early Histological Changes in the Porcine Aortic Media After Thoracic Stent-Graft Implantation

Thoracic endovascular repair first for extensive aortic disease: the staged hybrid approach

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