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      Left Subclavian Artery Revascularization for Delayed Paralysis after Thoracic Endovascular Aortic Repair

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          Abstract

          Spinal cord ischemia (SCI) is a devastating complication following thoracic endovascular aortic repair (TEVAR). A man with a ruptured thoracic aortic aneurysm (TAA) was transferred to our hospital. Emergency TEVAR, with left subclavian artery (LSA) coverage, was performed for the ruptured TAA. On postoperative day two, the patient had incomplete paralysis in his legs, presumably caused by SCI. We performed LSA revascularization (LSAR) to provide blood supply to the spinal cord; his paralysis improved and almost resolved after surgery. To our knowledge, this is the first report on LSAR’s efficacy for delayed paraplegia due to SCI.

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          2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine.

          Loren Hiratzka, George L. Bakris, Joshua A Beckman … (2010)
          Article 0 comments Cited 468 times – based on 0 reviews     Review now
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            Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept.

            R Griepp (2007)
            In the last two decades, as an increasing number of patients with descending thoracic and thoracoabdominal aneurysms are being diagnosed and treated, a more sophisticated understanding of spinal cord perfusion has become important in the attempt to minimize the frequency of spinal cord injury. The synthesis of information from laboratory studies and clinical experience has led to the collateral network concept, a framework for understanding spinal cord perfusion and thereby improving spinal cord protection during treatment of aneurysmal disease of the aorta distal to the left subclavian artery. Application of principles based on the collateral network concept has resulted in falling rates of spinal cord injury, which now approach 1% in descending thoracic aneurysm resection and less than 10% in extensive thoracoabdominal resections. These accomplishments suggest that, with further investigation, routine sacrifice of segmental aortic branches can be carried out in a way that will allow surgical and endovascular therapy of extensive distal aortic aneurysms without neurologic injury.
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              Spinal cord injury after thoracic endovascular aortic aneurysm repair.

              Hamdy Awad, Mohamed Ramadan, Hosam F El Sayed … (2017)
              Thoracic endovascular aortic aneurysm repair (TEVAR) has become a mainstay of therapy for aneurysms and other disorders of the thoracic aorta. The purpose of this narrative review article is to summarize the current literature on the risk factors for and pathophysiology of spinal cord injury (SCI) following TEVAR, and to discuss various intraoperative monitoring and treatment strategies.
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Vasc Dis
                Journal ID (iso-abbrev): Ann Vasc Dis
                Journal ID (pmc): avd
                Title: Annals of Vascular Diseases
                Publisher: Japanese College of Angiology / The Japanese Society for Vascular Surgery / Japanese Society of Phlebology (Italian Cultural Institute Building 8F, Kudan-Minami 2-1-30, Chiyoda-ku, Tokyo 102-0074, Japan )
                ISSN (Print): 1881-641X
                ISSN (Electronic): 1881-6428
                Publication date (Print): 25 June 2019
                Volume: 12
                Issue: 2
                Pages: 233-235
                Affiliations
                [1 ]Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
                Author notes
                [*] [* ]Corresponding author: Eisaku Nakamura, MD, PhD. Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Miyazaki 889-1692, Japan Tel: +81-985-85-2291, Fax: +81-985-85-5563, E-mail: ei-naka-1965@ 123456mtb.biglobe.ne.jp
                Article
                DOI: 10.3400/avd.cr.18-00158
                PMC ID: 6600088
                SO-VID: 28589806-108b-4acc-a3c4-2d9070c2c576
                Copyright © Copyright © 2019 Annals of Vascular Diseases
                License:

                ©2019 The Editorial Committee of Annals of Vascular Diseases. This article is distributed under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided the credit of the original work, a link to the license, and indication of any change are properly given, and the original work is not used for commercial purposes. Remixed or transformed contributions must be distributed under the same license as the original.

                History
                Date received : 9 December 2018
                Date accepted : 28 January 2019
                Categories
                Subject: Case Report

                Keywords: delayed paralysis,thoracic endovascular aortic repair,left subclavian artery revascularization
                Data availability:
                Keywords: delayed paralysis, thoracic endovascular aortic repair, left subclavian artery revascularization

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