Prevention of Spinal Cord Injury After Thoracoabdominal Aortic Aneurysm Repair

10.5772/20197 ◽  
2011 ◽  
Author(s):  
Takashi Kunihara ◽  
Suguru Kubota ◽  
Satoru Wakasa ◽  
Norihiko Shiiya ◽  
Yoshiro Matsui
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Aortic Aneurysm ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Cord Injury ◽  
Thoracoabdominal Aortic Aneurysm Repair ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Stent Graft Modification to Preserve Intercostal Arteries Using Thoracoabdominal Off-the-Shelf Multibranched (t-Branch) Endograft

2021 ◽  
pp. 152660282199671
Author(s):  
Marcelo Ferreira ◽  
Matheus Mannarino ◽  
Rodrigo Cunha ◽  
Diego Ferreira ◽  
Luis Fernando Capotorto ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Aneurysms ◽  
Specific Patient ◽  
Cord Injury ◽  
Proximal Extension ◽  
Thoracoabdominal Aortic Aneurysm Repair ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Purpose: To demonstrate an off-the-shelf multibranched (t-Branch) modification to allow intercostal arteries preservation during juxtarenal, pararenal, paravisceral, and extent IV thoracoabdominal aortic aneurysm repair. Technique: The t-Branch is an off-the-shelf device not customized for specific patient anatomy and may be offered for urgent endovascular repair for patients with complex aortic aneurysms. However, a concern when treating patients who do not aneurysms extending above the celiac axis is that the more proximal extension which is required with this device may render patients at high risk for spinal cord injury. We report a novel technique with t-Branch modification performing a 180° fabric back windows at the first 2 sealing stents that allow perfusion to the intercostal arteries. Conclusion: T-Branch-PIA (preserving intercostal arteries) modification limits intercostal arteries coverage while optimizing proximal seal zone in juxtarenal, pararenal, paravisceral, and extent IV thoracoabdominal aneurysms, thereby may decrease the risk of spinal cord injury.

A Systematic Review of the Use of Biochemical Markers in the Assessment of Spinal Cord Ischemia in Thoracoabdominal Aortic Aneurysm Repair

2018 ◽  
Vol 53 (3) ◽  
pp. 230-241 ◽  
Author(s):  
Andrew M. T. L. Choong ◽  
Ian J. Y. Wee ◽  
Mark Almond ◽  
Masafumi Muratani ◽  
Ferenc Kovari ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Aortic Aneurysm ◽  
Biochemical Markers ◽  
Spinal Cord Ischemia ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Specific Data ◽  
Cord Injury ◽  
Thoracoabdominal Aortic Aneurysm Repair ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Introduction: Despite advances in perioperative critical care and surgical technique, spinal cord ischemia remains a devastating complication of thoracic and thoracoabdominal aortic aneurysm repair. Biochemical markers present in peripheral blood and cerebrospinal fluid (CSF) may be useful in assessing spinal cord injury. We systematically analyze and report the role of all reported biochemical markers that have been used in assessing and diagnosing spinal cord ischemia in thoracic and thoracoabdominal aortic aneurysm repair. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for this review. Published literature was searched to identify all studies reporting on the use of biochemical markers in thoracoabdominal aortic aneurysm repair in the assessment of spinal cord ischemia. Marker-specific and patient-specific data were extracted from all studies and where possible, subgroup analysis was performed on marker-specific data sets. Results: Fourteen studies of 321 patients undergoing thoracic and thoracoabdominal aortic aneurysm repair were eligible for further analysis. Seven distinct biochemical markers were used in both CSF and blood samples: S100B proteins (S100B), neurone-specific enolase, lactate dehydrogenase, glial fibrillary acidic protein (GFAp), neurofilament triplet protein (NFL) and Tau protein, and glucose. There was substantial evidence demonstrating the heightened levels of S100, NFL, and GFAp in CSF in patients with spinal cord ischemia. There is however, wide variability in the correlation of the same 6 biochemical markers in peripheral blood and spinal cord ischemia. Conclusions: In patients with spinal cord injury, dramatic rises occur with S100B, NFL, and GFAp in CSF. However, further work is needed if biochemical markers are to impact on the future of thoracoabdominal aortic aneurysm repair.

scholarly journals The use of lumbar drains in preventing spinal cord injury following thoracoabdominal aortic aneurysm repair: an updated systematic review and meta-analysis

2016 ◽  
Vol 25 (3) ◽  
pp. 383-393 ◽  
Author(s):  
Nickalus R. Khan ◽  
Zachary Smalley ◽  
Cody L. Nesvick ◽  
Siang Liao Lee ◽  
L. Madison Michael
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Aortic Aneurysm ◽  
Meta Analysis ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Cochrane Library ◽  
Cord Injury ◽  
Aneurysm Repair ◽  
The Impact ◽  
Aortic Aneurysm Repair

OBJECTIVE Paraplegia and paraparesis following aortic aneurysm repair occur at a substantially high rate and are often catastrophic to patients, their families, and the overall health care system. Spinal cord injury (SCI) following open thoracoabdominal aortic aneurysm (TAAA) repair is reported to be as high as 20% in historical controls. The goal of this study was to determine the impact of CSF drainage (CSFD) on SCI following TAAA repair. METHODS In August 2015 a systematic literature search was performed using clinicaltrials.gov, the Cochrane Library, PubMed/MEDLINE, and Scopus that identified 3478 articles. Of these articles, 10 met inclusion criteria. Random and fixed-effect meta-analyses were performed using both pooled and subset analyses based on study type. RESULTS The meta-analysis demonstrated that CSFD decreased SCI by nearly half (relative risk 0.42, 95% confidence interval 0.25–0.70; p = 0.0009) in the pooled analysis. This effect remained in the subgroup analysis of early SCI but did not remain significant in late SCI. CONCLUSIONS This meta-analysis showed that CSFD could be an effective strategy in preventing SCI following aortic aneurysm repair. Care should be taken to prevent complications related to overdrainage. No firm conclusions can be drawn about the newer endovascular procedures at the current time.

Sign in / Sign up

Export Citation Format

Share Document