Thoracoabdominal Aneurysm Repair: A 20-Year Perspective

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…229 Risk factors for the development of SCI include prolonged aortic cross clamp time, extensive aneurysmal disease, aortic dissection, emergency surgery, internal iliac artery exclusion, and previous abdominal aortic procedures. Several strategies to limit neurological complications include distal aortic perfusion, intercostal artery reimplantation, 37 CSF drainage, 29,37,230 spinal cord cooling, 231 and assessment of spinal cord function peri-operatively 30 (see also Section 2.4.2. ).…”

Prevention of Spinal Cord Injury After Thoracoabdominal Aortic Aneurysm Repair

“…Using a multivariate analysis, many authors have also emphasized that type II TAAA emerges as an independent predictor for postoperative SCI (Safi et al, 2005, Conrad et al, 2007, Schepens et al, 2009, Acher et al, 2010. Other preoperative independent predictors for postoperative SCI have been reported such as an emergent setting (Conrad et al, 2007, Acher 2010, aortic dissection (Schepens et al, 2009, Acher 2010, age >75 years old (Schepens et al, 2009), and renal dysfunction (Safi et al, 2005(Safi et al, , 2008.…”

“…As shown later in Table 3, this classification correlates well with postoperative SCI still in contemporary era, thus it has been used widely to date. In the most extended type of TAAA (type II), SCI still occurs in 4.2-15.8% despite with experienced hands in the last decade (Safi et al, 2003, Jacobs et al, 2006, Coselli et al, 2007, Conrad et al, 2007, Zoli et al, 2010. Thus spinal cord protection during TAAA repair has emerged as great clinical importance.…”

Delayed Postoperative Paraplegia and Graft Infection after a Thoracoabdominal Dissection

“…[1][2][3] In contrast to immediate spinal cord deficits, delayed neurologic injury has attracted little attention in the literature and remains poorly understood. 4) Wong et al 5) in their review, reported that the rates of immediate and delayed paraplegia after major TAA repair are 1.7-8.1 and 0.8%-8.1%, respectively.…”

“…[1][2][3] In contrast to immediate spinal cord deficits, delayed neurologic injury has attracted little attention and remains poorly understood. 4) Graft infection is a life-threatening and treatment-resistant complication, especially after thoracoabdominal aneurysm repair.…”