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General Thoracic and Cardiovascular Surgery

, Volume 59, Issue 2, pp 79–90 | Cite as

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

  • Yutaka Okita
Current Topics Review Article

Abstract

Paraplegia or paraparesis after otherwise successful thoracic or thoracoabdominal aortic reconstruction is a devastating complication for both patient and physician. Various strategies have been developed to minimize the incidence of neurological complications after aortic surgery. The incidence of spinal cord ischemia and subsequent neurological complications has been correlated with (1) the duration and severity of ischemia, (2) failure to establish a spinal cord blood supply, and (3) reperfusion injury. Preoperative identification of the arteria radicularis magna, the artery of Adamkiewicz, facilitates identification of critical intercostal vessels for reimplantation, resulting in reestablishing spinal cord blood flow. Techniques for monitoring spinal cord function using evoked potentials have been developed, and surgical techniques have evolved to reduce the duration of ischemia. Furthermore, sequentially sacrificing all the intercostal arteries while maintaining collateral circulation to the cord has produced good outcomes. The severity of ischemia can be minimized by using cerebrospinal fluid drainage, hypothermia, distal bypass, managing the blood pressure, and adjunctive pharmacological therapy. Reperfusion injury can be reduced with the use of antioxidant therapy. Recent advances in endovascular stentgrafting have reduced the incidence of postoperative spinal complications, especially among high-risk patients.

Key words

Thoracoabdominal aorta Spinal cord ischemia Paraplegia 

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Copyright information

© The Japanese Association for Thoracic Surgery 2011

Authors and Affiliations

  1. 1.Division of Cardiovascular Surgery, Department of SurgeryKobe UniversityKobeJapan

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