The risk of ischemic spinal cord injury in patients undergoing graft replacement for thoracoabdominal aortic aneurysms

Abstract

The risk of ischemic spinal cord injury during replacement for TAA can be assessed continuously by monitoring the sSSEP directly from the spinal cord. Patients without sSSEP changes during aortic reconstruction do not require ICA reattachment and will not have neurologic deficit. Patients who lose sSSEP after AXC are at risk for paraplegia. Patients with impairment or loss of sSSEP >15 minutes after AXC have some collateral vessels, and must have ICAs reimplanted only if sSSEP do not return within normal recovery time after blood-flow release into the proximal anastomosis. Loss of sSSEP within 15 minutes of AXC shows poor collateralization and mandates early restoration of spinal cord blood supply. If the surgeon can achieve the return of sSSEP to normal by subsequent separate reimplantation of ICAS, paraplegia will not occur and paraparesis will be rare and mild. Spinal cord monitoring is a valuable guide to detect whether the spinal cord is at risk and to take measures against par

Comparison of Transcranial Motor Evoked Potentials and Somatosensory Evoked Potentials During Thoracoabdominal Aortic Aneurysm Repair

“…1,2 Numerous studies have described the use of somatosensory evoked potentials (SSEPs) during TAAA repair. [3][4][5][6] Although SSEPs were claimed to be beneficial, SSEPs combined with retrograde aortic perfusion did not improve neurologic outcome in a large prospective study. 7 In addition, false-negative and false-positive results were reported.…”

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

“…The implication, of course, was that intercostal vessel reconstruction was often ineffective as a "stand-alone" strategy, simply because it could not be performed rapidly enough. 4,24 These findings, together with the fact that when cord circulation is dependent on patent T 9 -L1 intercostal vessels (which are supported by distal aortic perfusion only during construction of the proximal aortic anastomoses), led us to rely on neuroprotective (rather then distal perfusion) strategies. These methods increase cord ischemic tolerance during the reconstruction, irrespective of the pattern of cord blood supply, until that supply is reestablished, either by intercostal reconstruction or removal of the crossclamp.…”

Diretrizes para a cirurgia das doenças da aorta

“…A principal preocupação na correção cirúrgica dos aneurismas descendentes ou toraco-abdominais ainda é a paraplegia, com incidência relatada entre 4 e 32% nos trabalhos recentes [145][146][147][148][149][150][151][152][153][154][155][156] . De fato, a injúria medular continua a ser um evento devastador para paciente, família e equipe cirúr-gica.…”