The adverse effect of back-bleeding from lumbar arteries on spinal cord pathophysiology in a rabbit model

Kawanishi, Yujiro; Okada, Kenji; Tanaka, Hiroshi; Yamashita, Teruo; Nakagiri, Keitaro; Okita, Yutaka

doi:10.1016/j.jtcvs.2006.10.066

Cited by 20 publications

(18 citation statements)

References 21 publications

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“…[41][42][43] The only case of spinal cord ischemia we reported in our series was a delayed transient paraplegia that occurred in 1 patient in the hybrid group in which an intercostal artery patch with a patent intercostal artery was unintentionally partially covered. The delayed symptoms completely resolved with emergent spinal fluid drainage.…”

Section: Discussionmentioning

confidence: 84%

Visceral aortic patch aneurysm after thoracoabdominal aortic repair: Conventional vs hybrid treatment

Tshomba

Bertoglio

Marone

et al. 2008

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 84%

Visceral aortic patch aneurysm after thoracoabdominal aortic repair: Conventional vs hybrid treatment

Tshomba

Bertoglio

Marone

et al. 2008

Journal of Vascular Surgery

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“…MEPs are used perioperatively to monitor spinal cord ischemia continuously. Some intercostal arteries responsible for the spinal cord ischemia are aggressively reattached according to the preoperative demonstration of the AKA by MRI or CT scans [67], while controlling back-bleeding from the other intercostal arteries without delay [68,69]. On the other hand, Kouchoukos et al employed systemic deep hypothermia for protection of the spinal cord as well as the brain in dTAA and TAAA repair in 1995 [70].…”

Section: Spinal Cord Protection During Aortic Surgerymentioning

confidence: 99%

Cardiovascular Surgical Technique Under Cardiopulmonary Bypass and Cerebrospinal Protection

Ogino

2015

Neuroanesthesia and Cerebrospinal Protection

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Brain and spinal cord injuries are some of the most troublesome sequelae during perioperative periods of cardiovascular surgery, which decrease the patient quality of life in the long term and can subsequently lead to serious morbidity and mortality. In cardiac surgery, one cause of perioperative cerebral complications is cardiopulmonary bypass (CPB). Off-pump coronary artery bypass grafting, particularly with a non-touch aortic technique, has been developed for preventing cerebral deficits. Other crucial issues are intraoperative examination of the ascending aorta with epiaortic echo and appropriate selection of alternative CPB cannulation sites such as the axillary or femoral arteries. On the other hand, in a variety of recently advanced endovascular aortic repair techniques, protection of the central nervous system is of greater concern, because the perfusion vessels of the brain, spinal cord, or both are involved in the surgical repairs. Hypothermia is still the underlying principle for cerebrospinal protection methods, because of the increased safety margin for preventing ischemic injury. Based on mild to moderate hypothermia, several kinds of antegrade and retrograde perfusion modalities are used for more secure protection. However, since they do not always provide complete cerebrospinal protection, several technical or pharmacological adjuncts should be added. These include precise preoperative examination of aortic and arterial lesions including identification of the Adamkiewicz artery, perioperative neuromonitoring with regional cerebral oxygenation and motor-evoked potentials, and various pharmacological methods.

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“…In a porcine experimental study, we found that controlling the back-fl ow from the intercostal arteries in the opened aorta maintained higher blood fl ow of the cord during aortic clamping and resulted in a better neurological outcome compared with the controls. 42 Griepp et al underscored the importance of clamping the intercostal arteries externally prior to opening the aorta to prevent cord ischemia. 43…”

Section: Effect Of Aortic Cross-clampingmentioning

confidence: 99%

“…53 We have experimentally demonstrated that controlling the intercostal back-fl ow in the porcine opened aorta could reduce the incidence of spinal cord ischemia. 42 Thus, external clamping of the intercostal arteries before opening the aneurysm or intraluminal insertion of a 2F balloon-tipped catheter into the intercostal arteries after opening the aneurysm is routine for minimizing blood refl ux from the intercostal arteries.…”

Section: Efforts To Minimize Blood Steal From the Spinal Cordmentioning

confidence: 99%

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

Okita

2011

Gen Thorac Cardiovasc Surg

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Paraplegia or paraparesis after otherwise successful thoracic or thoracoabdominal aortic reconstruction is a devastating complication for both patient and physician. Various strategies have been developed to minimize the incidence of neurological complications after aortic surgery. The incidence of spinal cord ischemia and subsequent neurological complications has been correlated with (1) the duration and severity of ischemia, (2) failure to establish a spinal cord blood supply, and (3) reperfusion injury. Preoperative identification of the arteria radicularis magna, the artery of Adamkiewicz, facilitates identification of critical intercostal vessels for reimplantation, resulting in reestablishing spinal cord blood flow. Techniques for monitoring spinal cord function using evoked potentials have been developed, and surgical techniques have evolved to reduce the duration of ischemia. Furthermore, sequentially sacrificing all the intercostal arteries while maintaining collateral circulation to the cord has produced good outcomes. The severity of ischemia can be minimized by using cerebrospinal fluid drainage, hypothermia, distal bypass, managing the blood pressure, and adjunctive pharmacological therapy. Reperfusion injury can be reduced with the use of antioxidant therapy. Recent advances in endovascular stentgrafting have reduced the incidence of postoperative spinal complications, especially among high-risk patients.

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The adverse effect of back-bleeding from lumbar arteries on spinal cord pathophysiology in a rabbit model

Cited by 20 publications

References 21 publications

Visceral aortic patch aneurysm after thoracoabdominal aortic repair: Conventional vs hybrid treatment

Visceral aortic patch aneurysm after thoracoabdominal aortic repair: Conventional vs hybrid treatment

Cardiovascular Surgical Technique Under Cardiopulmonary Bypass and Cerebrospinal Protection

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

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