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      Recovery of lost motor evoked potentials in open thoracoabdominal aortic aneurysm repair using intercostal artery bypass

      case-report

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          Abstract

          Ischemia of the spinal cord remains a disastrous complication in thoracoabdominal aortic aneurysm (TAAA) surgery. We report a case of open type I TAAA repair during which no motor evoked potentials were detectable for >1 hour after aortic cross-clamping. The creation of three intercostal artery bypasses restored spinal cord perfusion. As the patient showed only moderate clinical signs of spinal cord ischemia afterward, we underline the role of neuromonitoring to guide intercostal artery bypass implantation during TAAA surgery as the combined use of neuromonitoring and intercostal artery bypass implantation may prevent paraplegia in specific TAAA cases.

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          Experience with 1509 patients undergoing thoracoabdominal aortic operations.

          Joseph S. Coselli, J. Safi, K. Hess … (1993)
          The purpose of this study was to retrospectively identify variables associated with early death and postoperative complications in patients undergoing thoracoabdominal aortic operations. The data on 1509 patients who underwent 1679 thoracoabdominal aortic repairs between 1960 and 1991 were retrospectively reviewed. The median age was 66 years (range 1.5 years to 86 years), and aortic dissection was present in 276 (18%) patients. The extent of the first repair performed included 378 (25%) type I (proximal descending to upper abdominal aorta), 442 (29%) type II (proximal descending aorta to below the renal arteries), 343 (23%) type III (distal descending and abdominal aorta), and 346 (23%) type IV (most of the abdominal aorta). The median total aortic clamp time was 43 minutes. The 30-day survival rate was 92% (1386/1509) for the 30-year period. On multivariate analysis the preoperative and operative variables associated with death included (p 3 mg/dl or dialysis) occurred in 18% (269/1509) of patients; dialysis was required in 9% (136/1509). Gastrointestinal complications manifested in 7% (101/1509) of patients. Although the survival rate has improved, paraplegia/paraparesis and kidney failure continue to be vexing problems that require further research.
          Article 0 comments Cited 78 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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              The collateral network concept: Remodeling of the arterial collateral network after experimental segmental artery sacrifice

              Christian Etz, Fabian Kari, Christoph Mueller … (2011)
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                Author and article information

                Contributors
                Alexander Gombert
                Journal
                Journal ID (nlm-ta): J Vasc Surg Cases Innov Tech
                Journal ID (iso-abbrev): J Vasc Surg Cases Innov Tech
                Title: Journal of Vascular Surgery Cases and Innovative Techniques
                Publisher: Elsevier
                ISSN (Electronic): 2468-4287
                Publication date PMC-release: 27 February 2018
                Publication date Collection: March 2018
                Publication date (Electronic): 27 February 2018
                Volume: 4
                Issue: 1
                Pages: 54-57
                Affiliations
                [a ]European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
                [b ]Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
                Author notes
                [∗ ]Correspondence: Alexander Gombert, MD, European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074, Germany agombert@ 123456ukaachen.de
                Article
                Publisher ID: S2468-4287(18)30008-X
                DOI: 10.1016/j.jvscit.2017.12.004
                PMC ID: 5928281
                SO-VID: df1d4ad5-29f1-4071-be60-7947f3e9342b
                Copyright © © 2018 The Author(s)
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 13 September 2017
                Date accepted : 7 December 2017
                Categories
                Subject: Aortic aneurysm and dissection

                Data availability:

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