Traumatic tears of the thoracic aorta: Improved results using the bio-medicus pump

Hess, Philip J.; Howe, Harold R.; Robicsek, Francis; Daugherty, Harry K.; Cook, Joseph W.; Selle, Jay G.; Stiegel, Robert M.

doi:10.1016/0003-4975(89)90167-7

Cited by 48 publications

(7 citation statements)

References 11 publications

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“…Preischemic conditioning by temporary occlusion before cross-clamping may provide a certain degree of protection for the spinal cord 87 ; and reattachment of segmental arteries, especially from below T6 to L2, may be important even if the cross-clamping time is prolonged. 88 Svensson and colleagues studied 99 patients and found that if patent intercostals were oversewn the incidence of paraplegia was 37%; whereas if all patent intercostals and lumbar arteries were reattached, this incidence dropped to 6%. 6 Because of the often tenuous nature of the blood supply to the spinal cord, an aggressive approach to reattaching patent segmental arteries should be applied.…”

Section: Hypothermiamentioning

confidence: 95%

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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Section: Hypothermiamentioning

confidence: 95%

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

Okita

2011

Gen Thorac Cardiovasc Surg

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“…In the case of traumatic aortic lesions, conventional open repair with interposition grafting is the standard of care. After this type of procedure, paraplegia is the main complication; none of the pre-or intra-operative variables have been identified as the, most important risk factor of this feared event, and the cause is likely multifactorial (cross-clamp time, length of the thoracic aorta involved, systemic hypotension, low distal perfusion pressure, number of intercostal arteries excluded, body temperature, and cerebrospinal fluid pressure) (22,23). Different strategies and perfusion techniques have been described and are taken into consideration according to the injury's severity.…”

Section: Great Vessels Injuriesmentioning

confidence: 99%

Traumatic heart and great vessels injuries

et al. 2019

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“…post-traumatic aneurysms ranges from 0% to 10% and paraplegia accounts for 5% of cases. 33,34 The risk of paraplegia in surgery of chronic post-traumatic aneurysm is very low as compared to atherosclerotic ones, because of the limited extension of the pseudo-aneurysm that usually does not extend beyond the first pair of intercostal arteries (Fig. 2).…”

Section: Endovascular Management Of Acute and Chronic Casesmentioning

confidence: 99%