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 Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schurink, G. W. H. Articles by Jacobs, M. J. Search for Related Content PubMed PubMed Citation Articles by Schurink, G. W. H. Articles by Jacobs, M. J. Related Collections Great vessels

Ann Thorac Surg 2007;83:S877-S881
© 2007 The Society of Thoracic Surgeons

---

Supplement

Assessment of Spinal Cord Circulation and Function in Endovascular Treatment of Thoracic Aortic Aneurysms

^a Department of Vascular Surgery, University Hospital Maastricht, Maastricht, Netherlands
^b Department of Radiology, University Hospital Maastricht, Maastricht, Netherlands
^c Department of Neurophysiology, University Hospital Maastricht, Maastricht, Netherlands
^d Department of Cardiothoracic Surgery, University Hospital Maastricht, Maastricht, Netherlands

^_* Address correspondence to Dr Schurink, Department of Surgery, P Debyelaan 25, University Hospital Maastricht, Maastricht 6202 AZ, Netherlands. (Email: gwh.schurink{at}surgery.azm.nl).

Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.

BACKGROUND: In thoracic stent graft repair, the importance of segmental artery (SA) occlusion and the role of blood pressure management during the intraoperative and directly postoperative period are not clear. To study these aspects in relation to spinal cord ischemia, our protocol in the endovascular treatment of descending thoracic aneurysms covering segmental arteries T8 and lower includes preoperative assessment of the spinal cord circulation using magnetic resonance angiography, intraoperative cerebrospinal fluid drainage, and spinal cord function monitoring using motor evoked potentials (MEPs).

METHODS: Thirteen patients with thoracic aortic aneurysms and dissections needing stent graft coverage of T8 and lower were included. In 9 patients, spinal cord circulation was evaluated preoperatively by magnetic resonance angiography. In 12 patients, MEPs were recorded during the endovascular procedure. A combination of both techniques was used in 8 patients.

RESULTS: The distal stent graft landing zone covered the intercostal arteries up to T10 in 4 patients, up to T11 in 7 patients, up to T12 in 1 patient, and all SAs to the aortic bifurcation in 1 patient. In 6 patients, the SA feeding the Adamkiewicz artery was covered by the stent graft. In three patients, intersegmental collaterals were present to the SA feeding the Adamkiewicz artery. The MEPs decreased to 50% and 30% in 2 patients, recovering to levels above 50% by elevation of the mean arterial pressure. Postoperatively, no signs of paraplegia were present.

CONCLUSIONS: We believe that the presence of intersegmental collaterals decreases the risk of spinal cord ischemia during endovascular thoracic aortic aneurysm repair. Monitoring of MEPs during endovascular thoracic procedures shows no decrease in most cases. However, if a decrease of MEPs occurs, this can be reversed by elevation of the mean arterial pressure.

This article has been cited by other articles:

				W.H. Backes and R.J. Nijenhuis Advances in Spinal Cord MR Angiography AJNR Am. J. Neuroradiol., April 1, 2008; 29(4): 619 - 631. [Abstract] [Full Text] [PDF]