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Selective perfusion of segmental arteries in patients undergoing thoracoabdominal aortic surgery
- Source :
- The Annals of thoracic surgery. 70(1)
- Publication Year :
- 2000
-
Abstract
- Background . Reattachment of segmental arteries is one method used to prevent paraplegia associated with thoracoabdominal aortic repair. Nevertheless, even when important segmental arteries are reattached, ischemia causing spinal injury may occur during anastomosis. Methods . In 27 patients undergoing thoracoabdominal aortic repair, we attempted to perfuse the segmental arteries to be reattached with catheters connected to the distal bypass circuit. To identify perioperative risk factors for spinal ischemia, we examined changes in spinal somatosensory evoked potentials. Results . A median value of four segmental arteries were perfused in 20 (74%) of the 27 patients. Changes in somatosensory evoked potential indicative of spinal ischemia were observed in 13 patients (48%). The only risk factor associated with changes in evoked potentials revealed by a multivariate analysis was prolonged aortic cross-clamp time (> 120 minutes). Of the 2 patients who suffered paraplegia, one had the longest clamp time and the other showed spinal cord necrosis due to embolic shower. Conclusions . Despite selective perfusion of segmental arteries, spinal ischemia associated with aortic cross-clamping may occur when clamping is prolonged over 120 minutes. Most of the changes appear to be reversible, however.
- Subjects :
- Pulmonary and Respiratory Medicine
Adult
Male
Ischemia
Aorta, Thoracic
Anastomosis
Catheterization
Risk Factors
medicine.artery
medicine
Thoracic aorta
Humans
Aorta, Abdominal
Evoked Potentials
Aged
Postoperative Care
Intraoperative Care
business.industry
Spinal Cord Ischemia
Abdominal aorta
Middle Aged
medicine.disease
Spinal Artery
Perfusion
Spinal Cord
Somatosensory evoked potential
Anesthesia
Surgery
Female
Cardiology and Cardiovascular Medicine
Paraplegia
business
Vascular Surgical Procedures
Subjects
Details
- ISSN :
- 00034975
- Volume :
- 70
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- The Annals of thoracic surgery
- Accession number :
- edsair.doi.dedup.....4759229d2fba30525060f28b552b1d25