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Neue experimentelle Ansätze zur spinalen Ischämieprävention bei thorakalen und thorakoabdominalen Aorteneingriffen

New experimental approaches to prevent spinal ischemia after thoracic and thoracoabdominal aortic repair

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Eine zuverlässige Paraplegieprävention nach Unterbrechung segmentaler Zuflüsse zum Rückenmark bei aortenchirurgischen Eingriffen existiert nicht. Die Grundvoraussetzung für den zukünftigen klinischen Erfolg von endoluminalen und Hybridverfahren zur Behandlung ausgedehnter Aortenpathologien ist die Entwicklung verlässlicher Strategien für eine Neuroprotektion nach Verschluss von Segmentarterien.

Pathophysiologische Grundfragen der spinalen Kollateralisierung sind nicht beantwortet. Worauf begründet sich die Fähigkeit der Kollateralnetzwerke, nach akutem Segmentarterienverschluss innerhalb von Tagen wieder präoperative Perfusionsdrücke am Rückenmark zu etablieren? Sind dies Mechanismen, die für neue Präventionsansätze des Rückenmarkschadens genutzt werden können?

Dieser Beitrag erläutert wichtige funktionelle und anatomische Prinzipien der spinalen Kollateralisierung und diskutiert Arteriogenese als wenig untersuchte Option, eine präventive Protektion des Rückenmarks zu erreichen.

Abstract

There are no effective preventive measures to avoid paraplegia after interruption of segmental inflow to the spinal cord in aortic surgical procedures. Thus, the future clinical success of endovascular and hybrid procedures for the treatment of extensive aortic pathology requires the development of strategies for reliable neuroprotection after segmental artery occlusion.

Basic pathophysiologic questions concerning spinal collateralization have still not been answered. Which mechanisms contribute to the ability of spinal collateral networks to re-establish preoperative spinal perfusion pressures in the early post-operative period? Are these mechanisms useful to develop new approaches for prophylactic protection of the spinal cord?

This article demonstrates functional and anatomical principles of spinal collateralization, and discusses arteriogenesis as a new and poorly investigated option to achieve prophylactic protection of the spinal cord.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, One Gustave L. Levy Place, NY -10029, New York, USA

    F.A. Kari, C.S. Müller, R. Brenner, D. Silovitz, H.-M. Lin, R.B. Griepp & C.D. Etz

  2. Dr.-Barbara-Mez-Starck-Forschungslabor, Herz-Kreislauf-Zentrum Universitätsklinikum Freiburg, Elsässer Str. 2n, 79106, Freiburg, Deutschland

    F.A. Kari

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  1. F.A. Kari
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  2. C.S. Müller
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  3. R. Brenner
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  4. D. Silovitz
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  5. H.-M. Lin
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  6. R.B. Griepp
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  7. C.D. Etz
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Correspondence to F.A. Kari.

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Kari, F., Müller, C., Brenner, R. et al. Neue experimentelle Ansätze zur spinalen Ischämieprävention bei thorakalen und thorakoabdominalen Aorteneingriffen. Z Herz- Thorax- Gefäßchir 24, 42–48 (2010). https://doi.org/10.1007/s00398-009-0756-3

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