| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2002;74:S1821-S1824
© 2002 The Society of Thoracic Surgeons
a Department of Cardio-Thoracic Surgery, Nagoya University Graduate School of Medicine Nagoya, Japan
b Department of Radiology, Aichi Medical University, Nagoya, Japan
* Address reprint requests to Dr Usui, Department of Cardio-thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
e-mail: ausui{at}med.nagoya-u.ac.jp
Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.
Abstract
BACKGROUND: Endovascular stent grafting through a median sternotomy for a distal arch aneurysm (the frozen elephant trunk procedure) is an alternative to synthetic graft replacement. But spinal cord dysfunction can easily occur as a complication after surgery. Although its cause is uncertain, some attempts at prevention have been instituted. We address the mechanism of spinal cord dysfunction and evaluate the efficacy of our preventive measures.
METHODS: There were 22 men and 2 women with an average age of 71 (59 to 83) years. There were 22 true aneurysms (13 fusiform, nine saccular), one chronic dissection, and one penetrating aortic ulcer. The following strategies for prevention of spinal cord dysfunction were utilized: low flow perfusion through both axillary arteries (n = 10); pigtail catheter guidance (n = 19); use of a shorter graft with anchoring sutures (n = 12); flooding of the operative field with carbon dioxide (n = 7); aortic unclamping (n = 7), and use of ultra-thin woven Dacron grafts (n = 15).
RESULTS: There was no operative mortality, but cerebrospinal dysfunction complicated four cases (17%): one paraplegia, one stroke along the basilar artery, and two cases of temporary spinal cord dysfunction (paresthesia of the right leg and urinary disturbance). Cerebrospinal dysfunction tended to occur in fusiform aneurysms (31%, p = 0.044). Except when low flow antegrade perfusion through both the axillary arteries was utilized, which resulted in no cases of paraplegia or paraparesis (p = 0.064), the methods used for prevention of cerebrospinal dysfunction appeared to have little efficacy.
CONCLUSIONS: Cerebrospinal dysfunction is a serious complication of the frozen elephant trunk procedure. Its cause has not been clarified, but it tends to occur in fusiform-type aneurysms. Antegrade perfusion through both axillary arteries while the aorta is open may be helpful in its prevention.
This article has been cited by other articles:
|
|
 |
|
  M. Karck and H. Kamiya Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch? Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1007 - 1013. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Shimamura, T. Kuratani, G. Matsumiya, M. Kato, Y. Shirakawa, H. Takano, N. Ohta, and Y. Sawa Long-term results of the open stent-grafting technique for extended aortic arch disease. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1261 - 1269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Asano and Y. Okita The importance of distal fixation in total arch replacement for distal aortic arch aneurysm. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1188 - 1189. [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Pichlmaier, O. E. Teebken, H. Baraki, and A. Haverich The frozen elephant trunk technique MMCTS, March 29, 2007; 2007(0329): 1990. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Iwaki, S. Suzuki, T. Yajima, S. Yamauchi, M. Ochi, and K. Shimizu Use of open stent grafting for a mycotic aortic arch aneurysm J. Thorac. Cardiovasc. Surg., December 1, 2006; 132(6): 1462 - 1463. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Usui, H. Masumoto, T. Akita, M. Yoshikawa, H. Murayama, and Y. Ueda Multiple Penetrating Aortic Ulcers Ann. Thorac. Surg., February 1, 2006; 81(2): 750 - 750. [Full Text] [PDF]
|
|
|
|
|
|
L. G. Svensson Device discordancy: Lost cords, quick-fix seekers, quality, and ethics J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 261 - 263. [Full Text] [PDF]
|
|
|
|
|
|
J. Flores, T. Kunihara, N. Shiiya, K. Yoshimoto, K. Matsuzaki, and K. Yasuda Extensive deployment of the stented elephant trunk is associated with an increased risk of spinal cord injury J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 336 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Greenberg, F. Haddad, L. Svensson, S. O'Neill, E. Walker, S. P. Lyden, D. Clair, and B. Lytle Hybrid Approaches to Thoracic Aortic Aneurysms: The Role of Endovascular Elephant Trunk Completion Circulation, October 25, 2005; 112(17): 2619 - 2626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Karck, A. Chavan, N. Khaladj, H. Friedrich, C. Hagl, and A. Haverich The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up Eur. J. Cardiothorac. Surg., August 1, 2005; 28(2): 286 - 290. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Toyama, A. Usui, M. Yoshikawa, and Y. Ueda Thoracic aneurysm rupture due to graft perforation after endovascular stent-grafting via median sternotomy Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 162 - 164. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
