Ann Thorac Surg 1997;64:650
© 1997 The Society of Thoracic Surgeons
Discussion
Discussion
See also page 639.
DR ANTONIO LAUDITO (New York, NY): Doctor Coselli, would you please comment on your strategies to protect the spinal cord?
DR COSELLI: Well, our strategy has been primarily focused on patients with extensive aneurysms, the Crawford extent Is and the extent IIs, those at greatest risk for neurologic deficits. And in particular, we focus on those patients with dissection, which also happen to coincide numerically with patients with the greater extents; patients with dissections tend to have extent I and extent II aneurysms. In those individuals, we have primarily used left atrial to either femoral or distal aortic bypass and maintained distal perfusion of the lower intercostal arteries during a substantial portion of the repair to reduce the ischemic time to the spinal cord. Although it did not arise as a variable in this particular group of patients, in the overall group we found that it is at least numerically an improvement. That is the protection that I have used primarily. I have not used cerebrospinal fluid drainage or most of the other techniques.
In the lower aneurysms, the extent IlIs and the extent IVs, we have continued to use just a clamp and reconstruction technique.
DR DOUGLAS M. BEHRENDT (Iowa City, IA): Doctor Coselli, perhaps I missed it, but I did not note in your technical description that you make any special effort to reimplant intercostal or lumbar arteries in these kind of reconstructions.
DR COSELLI: In all patients, the technique was similar. We believe strongly that any patent intercostal arteries, from around T6 to T7 on down, that are reattachable ought to be reattached to the reconstruction and maintain the perfusion, with the idea that the direct blood supply to the spinal cord is highly likely to arise from this particular area of the aorta.
Related Article
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Impact of Previous Thoracic Aneurysm Repair on Thoracoabdominal Aortic Aneurysm Management
- Joseph S. Coselli, Luiz F. Poli de Figueiredo, and Scott A. LeMaire
Ann. Thorac. Surg. 1997 64: 639-650.
[Abstract]
[Full Text]
