Advertisement

Spinal Cord Perfusion and Protection During Surgical and Endovascular Treatment of Descending Thoracic and Thoracoabdominal Aortic Aneurysms

  • Eva B. Griepp
  • Randall B. Griepp
Conference paper

Although the treatment in aortic surgery centers of carefully selected patients with thoracic and thoracoabdominal aortic aneurysms by surgical and endovascular techniques yields acceptable results, the fact remains that the majority of patients with extensive aneurysms are too frail for surgical resection, and cannot be treated by endovascular techniques because of the inability to revascularize aortic branches. Promising techniques for revascularizing the four abdominal branches (extra-anatomical debranching and branched grafts) are under development, but the problem of preserving spinal cord perfusion and viability remains a major roadblock.

It is our belief, however, that routine sacrifice of all intercostal and lumbar vessels is well within reach, and only awaits a more thorough understanding of spinal cord perfusion. To this end, we have carried out a number of experimental studies in a chronic pig model in which neurological function can be monitored intraoperatively, blood flow can be ascertained using microspheres, and outcome can be assessed in terms of behavioral recovery and histology.

Keywords

Spinal Cord Spinal Cord Injury Segmental Artery Collateral Network Anterior Spinal Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Selected References

  1. Etz CD, Homann TM, Plestis KA, et al (2007) Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented? Eur J Cardiothorac Surg 31:643–648PubMedCrossRefGoogle Scholar
  2. Etz CD, Halstead JC, Spielvogel D, et al (2006) Thoracic and thoracoabdominal aneurysm repair: is reimplantation of spinal cord arteries a waste of time? Ann Thorac Surg 82:1670–1677PubMedCrossRefGoogle Scholar
  3. Etz CD, Homann TM, Plestis KA, et al (2007) Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented? Eur J Cardiothorac Surg 31:643–8PubMedCrossRefGoogle Scholar
  4. Etz CD, Luehr M, Kari FA, et al (2008) Paraplegia after extensive thoracic and thoracoabdominal aortic aneurysm repair: Does critical spinal cord ischemia occur postoperatively? J Thorac Cardiovasc Surg (in press)Google Scholar
  5. Griepp RB, Griepp EB (2007) Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept. Ann Thorac Surg 83:S865–S869; discussion S890–S892.PubMedCrossRefGoogle Scholar
  6. Halstead JC, Wurm M, Etz C, et al (2007) Preservation of spinal cord function after extensive segmental artery sacrifice: regional variations in perfusion. Ann Thorac Surg 84:789–794PubMedCrossRefGoogle Scholar
  7. Strauch JT, Spielvogel D, Lauten S, et al (2003) Importance of extrasegmental vessels for spinal cord blood supply in a chronic porcine model. Eur J Cardiothorac Surg 24:817–824PubMedCrossRefGoogle Scholar
  8. Strauch JT, Lauten A, Spielvogel D, et al (2004) Mild hypothermia protects the spinal cord from ischemic injury in a chronic porcine model. Eur J Cardiothorac Surg 25:708–715PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Eva B. Griepp
    • 1
  • Randall B. Griepp
    • 1
  1. 1.Department of Cardiothoracic SurgeryThe Mount Sinai School of MedicineNew YorkUSA

Personalised recommendations