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Intercostal Artery Reconstruction: The Simple and Effective Technique on Spinal Cord Protection during Thoracoabdominal Aortic Replacement
- Source :
- Annals of vascular surgery. 34
- Publication Year :
- 2015
-
Abstract
- Background To retrospectively analyze the role of intercostal artery reconstruction in the spinal cord protection for patients undergoing extensive thoracoabdominal aortic aneurysm repair. Methods From August 2007 to 2014, thoracoabdominal aortas (Crawford II) of 81 consecutive patients with mean age 39.4 ± 10.32 years were repaired. Seventy-three of these patients (90.12%) were diagnosed with aortic dissection in our group, 25 (30.86%) with Stanford type A dissection and 48 (59.26%) with Stanford B aortic dissection. All 25 patients with type A dissection have previously undergone surgical procedures which include Bentall's procedures in 11 cases, ascending aortic replacement in 6 cases, and total aortic arch replacement in 8 cases. All procedures were performed under profound hypothermia with interval cardiac arrest after making a thoracoabdominal incision. Extracorporeal circulation was instituted with 2 arterial cannulae and a single venous cannula in the right atrium. T6–T12 intercostal arteries and L1 and L2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8 mm branch for maintaining spinal cord blood perfusion. Visceral arteries were joined into a patch and anastomosed to the end of the main graft. The left renal artery was anastomosed to an 8 mm branch or joined to the patch. The other 10 mm branches were anastomosed to iliac arteries. Results With 100% follow-up, early mortality was 7.4%. Six deaths were recorded; 1 patient died of cerebral hemorrhage, 3 of renal failure, 1 of heart failure because of myocardial infarction, and the last one died from the rupture of celiac artery dissection. The rate of postoperative spinal cord deficits was 3.7%, 2 patients with paraplegia and 1 patient with paraparesis. None had bladder or rectum dysfunction. Neo-intercostal arteries were clogged in 12 patients within follow-up period and formed pseudoaneurysm in 2 patients with Marfan syndrome. The mean survival time in this group was 54.22 ± 3.03 months (95% confidence interval 44.37–59.90 months) with survival rate of 92.37% after 1 year, 89.02% after 2 years, and 85.54% after 5 years. All patients were free from spinal cord deficits. Conclusions Intercostal artery reconstruction is an effective technique for spinal cord protection in patients with the thoracoabdominal aortic repair. It can achieve favorable results and avoid spinal cord deficits with long-term follow-up.
- Subjects :
- Adult
Male
medicine.medical_specialty
Aortography
Time Factors
Dissection (medical)
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
03 medical and health sciences
Aortic aneurysm
Pseudoaneurysm
Blood Vessel Prosthesis Implantation
0302 clinical medicine
Thoracic Arteries
Paraparesis
Risk Factors
medicine.artery
medicine
Humans
Retrospective Studies
Aortic dissection
Paraplegia
medicine.diagnostic_test
Aortic Aneurysm, Thoracic
business.industry
Spinal Cord Ischemia
Anastomosis, Surgical
General Medicine
Middle Aged
Plastic Surgery Procedures
medicine.disease
Surgery
Aortic Dissection
Treatment Outcome
030228 respiratory system
Spinal Cord
Regional Blood Flow
Anesthesia
Female
Cardiology and Cardiovascular Medicine
business
Tomography, X-Ray Computed
Intercostal arteries
Lumbar arteries
Subjects
Details
- ISSN :
- 16155947
- Volume :
- 34
- Database :
- OpenAIRE
- Journal :
- Annals of vascular surgery
- Accession number :
- edsair.doi.dedup.....61632e1d72bc91f923ee865413e84823