Spinal Cord Perfusion and Protection During Surgical and Endovascular Treatment of Descending Thoracic and Thoracoabdominal Aortic Aneurysms
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.
KeywordsSpinal Cord Spinal Cord Injury Segmental Artery Collateral Network Anterior Spinal Artery
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