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Aortic aneurysm paralysis spinal cord

Hamdy Awad, Mohamed Ehab Ramadan, Hosam F El Sayed, Daniel A Tolpin, Esmerina Tili, Charles D Collard
PURPOSE: 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. SOURCE: The articles considered in this review were identified through PubMed using the following search terms: thoracic aortic aneurysm, TEVAR, paralysis+TEVAR, risk factors+TEVAR, spinal cord ischemia+TEVAR, neuromonitoring+thoracic aortic aneurysm, spinal drain, cerebrospinal fluid drainage, treatment of spinal cord ischemia...
December 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Kayoko Natsume, Norihiko Shiiya, Katsushi Yamashita, Naoki Washiyama
We report the case of a patient who developed paraparesis 2 days after endovascular aneurysm repair for a right common iliac aneurysm. The patient had undergone thoracic endovascular aortic repair. The left subclavian artery was occluded, but the left internal iliac artery was preserved. The patient fully recovered from the paralysis within 3 months. This case illustrates the importance of collateral blood supply to the spinal cord from the lumbosacral region, especially when other sources are occluded.
November 1, 2017: Interactive Cardiovascular and Thoracic Surgery
Liang He, Jun-Mei Xu, Hui Li, Feng Zhong, Zhi Liu, Chang-Qi Li, Ru-Ping Dai
BACKGROUND: Hypothermia reduces immediate paralysis during surgical repair of aortic aneurysms. However, it is unknown what the impact of hypothermia is on delayed paralysis, a serious complication of this type of surgery. METHODS: Sprague-Dawley rats were subjected to occlusion of the descending aorta at different duration under normothermia (38.0±0.5) or hypothermia (33.0±0.5°). Neurologic function was assessed. Motor neuron number, glial activation, and cytokine expression in the spinal cord were examined...
October 1, 2016: International Journal of Cardiology
Lucy Y Liu, Brooke Callahan, Sven Peterss, Julia Dumfarth, Maryann Tranquilli, Bulat A Ziganshin, John A Elefteriades
BACKGROUND: Motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) are established methods of neuromonitoring aimed at preventing paraplegia after descending or thoracoabdominal aortic repair. However, their predictive impact remains controversial. The aim of this study was to evaluate our single-center experience using this monitoring technique. METHODS: Between 2009 and 2014, 78 patients (mean age 66 ± 12, 53% male) underwent either descending or thoracoabdominal aortic repairs...
June 2016: Journal of Cardiac Surgery
Martha Wynn, Charles Acher, Erich Marks, C W Acher
OBJECTIVE: Intercostal artery (ICA) reimplantation (ICAR) is thought to decrease spinal cord injury (SCI) in thoracic aortic aneurysm and thoracoabdominal aortic aneurysm (TAAA) surgery. Patients treated from 1989 to 2005 without ICAR were compared with those treated from 2005 to 2013 with ICAR to determine whether ICAR reduced SCI. We hypothesized that ICAR would reduce SCI, especially in the highest-risk patients. METHODS: This was a retrospective analysis using a prospectively maintained Investigational Review Board-approved database from a university tertiary referral center...
August 2016: Journal of Vascular Surgery
Ihsan Ates, Mustafa Kaplan, Merve Özçalık, Nisbet Yılmaz
Thrombosis due to abdominal aortic aneurysm is a rare condition that causes high mortality. Transient ischemic attack of the spinal cord can occur as a result of trash emboli from thrombus in abdominal aortic aneurysm. This condition generally occurs during operation of abdominal aortic aneurysm; very rarely, it can also be seen in laminated abdominal aortic aneurysm. Here, we present a case of a patient presenting with bilateral lower extremity paralysis resulting from transient ischemic attack of the spinal cord due to infrarenal abdominal aortic aneurysm...
January 2016: Annals of Vascular Surgery
Alessandro Vivacqua, Jay J Idrees, Douglas R Johnston, Edward G Soltesz, Lars G Svensson, Eric E Roselli
OBJECTIVES: Repair of extensive aortic disease carries a significant risk of death and morbidity, the most feared complication being spinal cord ischaemia. Objectives of this study are to characterize patients, describe repair methods and assess feasibility and safety of hybrid staged repair for treatment of extensive aortic disease. METHODS: From to 2001 to 2013, 22 patients underwent extensive aortic repair that included a thoracic endovascular aortic repair (TEVAR) first followed by an open completion repair extending through the visceral and infrarenal aorta for degenerative aneurysm and dissection...
March 2016: European Journal of Cardio-thoracic Surgery
Karl A Illig, Takao Ohki, G Chad Hughes, Masaaki Kato, Hideyuki Shimizu, Himanshu J Patel, Ali Shahriari, Shraddha Mehta
OBJECTIVE: This study evaluated the safety and effectiveness of the Zenith Alpha Thoracic Endovascular Graft (Cook Medical, Bloomington, Ind) for the treatment of descending thoracic aortic aneurysms and large ulcers. METHODS: The Zenith Alpha Thoracic Endovascular Graft, with a 16F to 20F delivery system, was developed to address vascular access issues associated with larger-profile devices and to increase conformability in tortuous anatomy. This prospective, nonrandomized, multicenter study was conducted in Europe, Japan, and the United States...
December 2015: Journal of Vascular Surgery
Muhammad Usman Ali Shah, Rashad Siddiqi, Muhammad Sohail Chaudhri, Asif Ali Khan, Imtiaz Chaudhry
A young man presented with hoarseness of voice and was found to have left vocal cord paralysis and a large opacity on chest X-ray in the left upper zone. CT angiography showed a giant aneurysm of the aortic arch involving the left subclavian artery. Using a dual perfusion system, with the femoral bypass circuit taking care of the spinal protection and the aortic bypass circuit providing the cerebral protection, the aneurysm was excised and a 16 mm Dacron graft was anastomosed to the aortic arch and the left subclavian artery was anastomosed to the interposition graft...
April 2014: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Joseph L Bobadilla, Martha Wynn, Girma Tefera, C W Acher
OBJECTIVE: Paraparesis and paraplegia after thoracic endovascular aneurysm repair (TEVAR) is a greatly feared complication. Multiple case series report this risk up to 13% with no, or inconsistent, application of interventions to enhance and protect spinal cord perfusion. In this study, we report our single-institution experience of TEVAR, using the same proactive spinal cord ischemia protection protocol we use for open repair. METHODS: Endovascular thoracic aortic interventions were performed for both on-label (aneurysm) and off-label (trauma, other) indications...
June 2013: Journal of Vascular Surgery
Linda M Reilly, Joseph H Rapp, S Marlene Grenon, Jade S Hiramoto, Julia Sobel, Timothy A M Chuter
OBJECTIVE: This study determined early and intermediate results of multibranched endovascular thoracoabdominal (TAAA) and pararenal aortic aneurysm (PRAA) repair using a uniform operative technique. METHODS: Eighty-one patients (mean age, 73 ± 8 years, 19 [23.5%] women) underwent endovascular TAAA repair in a prospective trial using self-expanding covered stents connecting axially oriented, caudally directed cuffs to target aortic branches. Mean aneurysm diameter was 67 ± 10 mm...
July 2012: Journal of Vascular Surgery
Nimesh D Desai, Alberto Pochettino, Wilson Y Szeto, G William Moser, Patrick J Moeller, Nishtha Sodhi, Benjamin Jackson, Edward Woo, Ronald M Fairman, Joseph Bavaria
OBJECTIVE: The introduction of aortic stent grafting in the treatment of thoracic aortic disease has pioneered unique treatment options and gained rapid clinical adoption despite a paucity of long-term outcome data. The purpose of this analysis is to examine all operations performed using thoracic aortic stent grafts at the University of Pennsylvania Health System. METHODS: A total of 502 operations involving thoracic aortic stent grafting were performed between April 1999 and April 2009...
September 2011: Journal of Thoracic and Cardiovascular Surgery
Rodney A White, D Craig Miller, Frank J Criado, Michael D Dake, Edward B Diethrich, Roy K Greenberg, Rebecca S Piccolo, Flora Sandra Siami
OBJECTIVE: This study analyzed 1-year outcome after thoracic endovascular aortic repair (TEVAR) in patients with complicated type B aortic dissection (cTBAoD) who had rupture or malperfusion and symptom onset ≤14 days (acute), 15 to 30 days (subacute), and 31 to 90 days (chronic) until required intervention. The main focus of this report is primarily on the acute cohort. METHODS: Clinical data were systematically collected from five physician-sponsored investigational device exemption (IDE) clinical trials between 2000 and 2008 using standardized definitions and forms...
April 2011: Journal of Vascular Surgery
Takeshi Kamada, Kenji Minatoya, Masahiro Wakimoto, Mamoru Kadosaki, Ryoichi Tanaka, Kunihiro Yoshioka, Akihiko Abiko, Hitoshi Okabayashi
Spinal cord ischemia (SCI) is one of the most serious complications in patients who undergo thoracic endovascular aortic repair (TEVAR). The incidence of SCI after TEVAR has been supposed to be lower than the one after traditional open surgical repair. However, not a few cases regarding SCI after TEVAR have been reported recently. Since the detailed mechanism of the SCI is still not fully understood, preventive strategies against SCI including preoperative identification of critical segmental artery (CSA) applying the artery of Adamkiewicz, preservation of the CSA, motor evoked potential (MEP) monitoring, and cerebrospinal fluid (CSF) drainage are routinely performed during TEVAR in our practice...
January 2011: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Katsuaki Magishi, Yuichi Izumi, Noriyuki Shimizu
We report a case of aortic dissection due to improper position of a percutaneous cardiopulmonary support (PCPS) cannula into the femoral artery during coronary artery bypass grafting (CABG). A 77-year-old man with 3-vessel disease underwent off-pump CABG (OPCAB). Blood pressure suddenly lowered during bypass grafting to the right coronary artery. PCPS was performed between the left femoral artery and the right atrium. Bradycardia occurred 37 min after initiation of PCPS, and transesophageal echocardiography revealed Stanford type A aortic dissection...
December 2010: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Toshinori Horiuchi, Masahiko Kawaguchi, Satoki Inoue, Hironobu Hayashi, Ryuichi Abe, Nobuoki Tabayashi, Shigeki Taniguchi, Hitoshi Furuya
PURPOSE: Monitoring motor evoked potentials (MEPs) has been recognized as a highly reliable method to detect intraoperative spinal cord ischemia (SCI) in aortic repair. However, the data regarding the sensitivity and specificity of MEPs for predicting postoperative paraplegia are limited. We retrospectively assessed the value of intraoperative MEP amplitudes for predicting postoperative paraplegia. METHODS: The medical records of 44 patients were reviewed. A train-of-five stimulation was delivered to C3-C4, and MEPs were recorded from the abductor pollicis brevis and the tibialis anterior muscles...
February 2011: Journal of Anesthesia
Mark F Conrad, Thomas K Chung, Matthew R Cambria, Vikram Paruchuri, Thomas J Brady, Richard P Cambria
OBJECTIVE: Although chronic aortic dissection (CD) has traditionally been considered a predictor of perioperative morbidity and mortality after descending thoracic/thoracoabdominal aneurysm repair (thoracoabdominal aortic aneurysm [TAA]), recent reports have rejected this assertion. Still, few contemporary studies document late outcomes after TAA for CD, which is the goal of this study. METHODS: From August 1987 to December 2005, 480 patients underwent TAA; 73 (15%) CD and 407 (85%) degenerative aneurysms (DA)...
March 2011: Journal of Vascular Surgery
Hamdy Awad, Daniel P Ankeny, Zhen Guan, Ping Wei, Dana M McTigue, Phillip G Popovich
BACKGROUND: Spinal cord ischemia and paralysis are devastating perioperative complications that can accompany open or endovascular repair surgery for aortic aneurysms. Here, we report on the development of a new mouse model of spinal cord ischemia with delayed paralysis induced by cross-clamping the descending aorta. METHODS: Transient aortic occlusion was produced in mice by cross-clamping the descending aorta through a lateral thoracotomy. To establish an optimal surgical procedure with limited mortality, variable cross-clamp times and core temperatures were tested between experiments...
October 2010: Anesthesiology
Cuong H Lam, Geogy Vatakencherry
Paralysis and paraparesis are dreaded complications of thoracic endovascular aortic repair (TEVAR) that occur with an incidence of 2%-6%. Risks factors include the type of thoracic aortic pathology treated, coverage of the left subclavian artery origin without revascularization, concomitant infrarenal abdominal aortic aneurysm repair, extent of stent graft coverage of the thoracic aorta, and renal failure. Cerebral spinal fluid (CSF) drains have been advocated as one of several protective strategies to prevent spinal cord ischemia...
September 2010: Journal of Vascular and Interventional Radiology: JVIR
H Ohtake, J Sanada, K Kimura, O Matsui, G Watanabe
BACKGROUND: The position of thoracic endovascular aortic repair (TEVAR) compared to open surgery of the thoracic aorta has changed. This study evaluates outcomes after TEVAR performed electively using our original Matsui-Kitamura stent graft (MKSG) to treat descending thoracic aortic aneurysms (dTAA) and chronic type-B aortic dissection (type-B AD), and elucidates the risk factors for postoperative spinal cord ischemia (SCI). METHODS: TEVAR was performed using an MKSG in 66 patients (age: 70...
August 2010: Thoracic and Cardiovascular Surgeon
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