Strategies for prevention and treatment of spinal cord ischemia during F/BEVAR

Motyl, Claire M.

doi:10.1053/j.semvascsurg.2022.06.005

Cited by 9 publications

(3 citation statements)

References 52 publications

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“…Cerebrospinal fluid drainage was the most effective method for the prevention and treatment of paraplegia after endovascular aortic repair. [ 18 ] The spinal perfusion pressure was equal to the difference between mean arterial pressure and cerebrospinal fluid pressure. [ 19 – 21 ] Early cerebrospinal fluid drainage reduces the cerebrospinal fluid pressure and increases the spinal perfusion pressure to relieve symptoms.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation report of 2 cases of spinal cord ischemic injury after intra-aortic repair

Cheng,

Li,

Zhang

et al. 2024

Medicine

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Rationale: Spinal cord ischemia injury is a serious complication after intra-aortic surgery, with a low incidence but high disability rate. However, patients often do not receive comprehensive treatment in the early stages of the disease. Therefore, active neurological intervention is needed to protect and prevent spinal cord ischemia during and after surgery. In this paper, rehabilitation program and imaging data of 2 cases with spinal cord ischemic injury are presented and discussed regarding causes, prevention and acute treatment with this disease, which could be referred by clinicians. Patient concerns: Case report 1: A 69-year-old male patient underwent aortic arch aneurysm and thoracic endovascular aortic repair (coated stent) was performed under general anesthesia. Complete paralysis of both lower limbs, constipation, and urinary retention occurred after surgery and was subsequently referred to our rehabilitation department. Case report 2: A man aged 41 years experienced sudden chest pain with no dizziness or headache. Weakness of both lower limbs gradually appeared over 30 minutes with subsequent loss of consciousness. He was diagnosed with aortic dissection and underwent aortic stent implantation. Inpatient rehabilitation began systematically 3 months after discharge. Diagnoses: The 2 patients were diagnosed with paraplegia and spinal cord ischemic injury. Interventions: The patients received strength and transfer training, sensory input, health mission, and activities of daily living. Outcomes: Patient 1 returned home without assistive devices and patient 2 returned home with wheelchair. Lessons: Perioperative spinal cord protection is directly related to postoperative quality of life. Once the symptoms of spinal cord ischemic injury occur, cerebrospinal fluid drainage should be performed as soon as possible to increase mean arterial pressure. At the same time, methylprednisolone, ganglioside, anticoagulation, vasodilator drugs, and symptomatic supportive treatments are required. Intercostal artery and subclavian artery are reconstructed if necessary. Symptom stability flags referral to commence rehabilitation. Repetitive functional training is necessary to help patients return to the family and society as soon as possible.

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Section: Discussionmentioning

confidence: 99%

Rehabilitation report of 2 cases of spinal cord ischemic injury after intra-aortic repair

Cheng,

Li,

Zhang

et al. 2024

Medicine

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“…Therefore, utilizing the TF approach may be a preferable option whenever possible to minimize the risk of cerebral embolic events and stroke [54] . Despite theoretical concerns regarding a potential increased risk of stroke associated with right UE access compared to left UE access, studies have shown no significant difference [55] .…”

Section: Access Vesselmentioning

confidence: 99%

Current state of endovascular repair of thoracoabdominal aortic aneurysms

Rodrigues,

Lima,

DeMartino

et al. 2024

Vessel Plus

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Thoracoabdominal aortic aneurysm (TAAA) is a severe and complex condition with multifactorial etiology that can lead to life-threatening complications. Its treatment is genuinely complex irrespective of the chosen technique, open or endovascular repair. Fenestrated-branched endovascular aneurysm repair (F/B-EVAR) has been increasingly accepted in patients with suitable anatomy, resulting in outcomes compared to or superior to open repair. The selection of patients, judicious surgical planning, and device selection are paramount to achieving successful treatment. The field of TAAA repair is continuously evolving with ongoing research and the development of new techniques and devices to further improve patient outcomes. This paper aims to present a review of endovascular TAAA treatment, summarizing anatomical and clinical features relevant to technical performance and treatment indications.

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“…TASP has shown benefit when compared with single-stage repair; a study of 83 patients who underwent branched endovascular aortic repair (EVAR) with or without TASP demonstrated a significantly lower rate of SCI with TASP ( 13 ). However, this practice has not been investigated in US centers, owing to two primary reasons; the first being that it has not been compared with conventional means of staged repair, and the second is the theoretical risks with TASP, namely coagulopathy related to high flow endoleaks, and the risk of rupture ( 14 ).…”

Section: Anatomy Of Spinal Cord Perfusionmentioning

confidence: 99%

Spinal cord protection for thoracoabdominal aortic aneurysm repair: from bench to bedside

Carroll,

King,

Ghincea

et al. 2023

Ann Cardiothorac Surg

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This keynote lecture and corresponding presentation discuss the anatomy and pathophysiology surrounding spinal cord injury in aortic surgery. This article will discuss risk factors and mechanisms for spinal cord injury, including loss of direct and collateral spinal cord perfusion and ischemia-reperfusion injury. This review will examine these elements in both the laboratory and clinical setting, in addition to other neuroprotective strategies applied in clinical practice. Addressing spinal cord injury requires an integrated and considerate approach to simultaneously optimize spinal cord blood flow, promote collateralization and improve ischemic tolerance. Given the catastrophic clinical consequences for both the patient and their caregivers, continuing to investigate and examine spinal cord injury is of the utmost importance.

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Strategies for prevention and treatment of spinal cord ischemia during F/BEVAR

Cited by 9 publications

References 52 publications

Rehabilitation report of 2 cases of spinal cord ischemic injury after intra-aortic repair

Rehabilitation report of 2 cases of spinal cord ischemic injury after intra-aortic repair

Current state of endovascular repair of thoracoabdominal aortic aneurysms

Spinal cord protection for thoracoabdominal aortic aneurysm repair: from bench to bedside

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