HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thoralf M. Sundt, III Marc R. Moon Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Maniar, H. S. Articles by Sicard, G. A. Search for Related Content PubMed PubMed Citation Articles by Maniar, H. S. Articles by Sicard, G. A. Related Collections Great vessels

Ann Thorac Surg 2003;75:113-120
© 2003 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Delayed paraplegia after thoracic and thoracoabdominal aneurysm repair: a continuing risk

^a Division of Cardiothoracic Surgery, St. Louis, Missouri, USA
^b Division of Vascular Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

* Address reprint requests to Dr Sundt, Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
e-mail: sundt.thoralf{at}mayo.edu

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

BACKGROUND: Paraplegia or paraparesis after otherwise successful thoracic or thoracoabdominal aortic reconstruction is a devastating complication for patient and physician. Interventions for its prevention have focused primarily on the intraoperative period. We have recently noted a significant incidence of delayed-onset neurologic deficit.

METHODS: We reviewed our most recent 5-year experience with thoracic and thoracoabdominal reconstruction to examine the incidence of and potential contributors to delayed paraplegia or paraparesis.

RESULTS: Between June 1996 and June 2001, 60 patients (29 men, 31 women) underwent repair of isolated thoracic (n = 26) or thoracoabdominal aortic aneurysm (Crawford I, n = 7; Crawford II, n = 14; Crawford III, n = 12; Crawford IV, n = 1) by the cardiac and vascular surgical services collaboratively. Repair was performed endovascularly in 6, and open with either circulatory arrest in 12, partial left heart bypass in 37, or partial femorofemoral bypass in 5. Operative mortality was 9.3% (5 of 54 patients) for open repair and 0% for endovascular repair. Paraplegia or paraparesis occurred in 6 (10%) patients of which 83.3% (5 of 6) were delayed in onset. All patients with delayed paraplegia or paraparesis had degenerative aneurysms of Crawford extent II (n = 3) or III (n = 2), had intraoperative left heart bypass, and had perioperative spinal drainage. Delayed paraplegia or paraparesis occurred up to 27 days postoperatively, and was associated with a documented episode of hypotension in 60% (3 of 5) of patients.

CONCLUSIONS: Improvements in intraoperative management may have reduced immediate paraplegia or paraparesis among vulnerable patients only to leave them at risk of delayed-onset deficit. Postoperative care, including assiduous attention to avoidance of even transient hypotension, must be tailored to this patient population.

This article has been cited by other articles:

				T. Horiuchi, M. Kawaguchi, N. Kurita, S. Inoue, M. Nakamura, N. Konishi, and H. Furuya The Long-Term Effects of Mild to Moderate Hypothermia on Gray and White Matter Injury After Spinal Cord Ischemia in Rats Anesth. Analg., August 1, 2009; 109(2): 559 - 566. [Abstract] [Full Text] [PDF]

				M. P. Siegenthaler, E. Weigang, K. Brehm, W. Euringer, T. Baumann, M. Uhl, S. Raghu, and F. Beyersdorf Endovascular treatment for thoracoabdominal aneurysms: outcomes and results Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 810 - 819. [Abstract] [Full Text] [PDF]

				Y. Kawanishi, K. Okada, M. Matsumori, H. Tanaka, T. Yamashita, K. Nakagiri, and Y. Okita Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair Ann. Thorac. Surg., August 1, 2007; 84(2): 488 - 492. [Abstract] [Full Text] [PDF]

				D. R. Wong, J. S. Coselli, K. Amerman, J. Bozinovski, S. A. Carter, W. K. Vaughn, and S. A. LeMaire Delayed Spinal Cord Deficits After Thoracoabdominal Aortic Aneurysm Repair Ann. Thorac. Surg., April 1, 2007; 83(4): 1345 - 1355. [Abstract] [Full Text] [PDF]

				A. Zierer, S. J. Melby, J. G. Lubahn, G. A. Sicard, R. J. Damiano Jr, and M. R. Moon Elective Surgery for Thoracic Aortic Aneurysms: Late Functional Status and Quality of Life Ann. Thorac. Surg., August 1, 2006; 82(2): 573 - 578. [Abstract] [Full Text] [PDF]

				P. W.G. Elbers, P. de Haan, I. Vanicky, D. Legemate, and M. Dzoljic Effect of Temporary Visceral Ischemia on Spinal Cord Ischemic Damage in the Rabbit Ann. Thorac. Surg., March 1, 2006; 81(3): 910 - 917. [Abstract] [Full Text] [PDF]

				I. Hunt, R. P. Deshpande, C. Aps, and C. P. Young Delayed Paraplegia After Thoracic and Thoracoabdominal Aneurysm Repair: Timing of Reinsertion of Spinal Drain Ann. Thorac. Surg., December 1, 2004; 78(6): 2213 - 2213. [Full Text] [PDF]

				T. M. Sundt III Reply Ann. Thorac. Surg., December 1, 2004; 78(6): 2214 - 2214. [Full Text] [PDF]

				M. Uzieblo, L. A. Sanchez, B. G. Rubin, E. T. Choi, P. J. Geraghty, M. W. Flye, J. A. Curci, M. R. Moon, and G. A. Sicard Endovascular Repair of Traumatic Descending Thoracic Aortic Disruptions: Should Endovascular Therapy Become the Gold Standard? Vascular and Endovascular Surgery, July 1, 2004; 38(4): 331 - 337. [Abstract] [PDF]