[Surgical treatment for thoracoabdominal aortic aneurysm].
Spinal cord injury such as paraparesis and paraplegia remains one of the major concerns in surgery on the thoracoabdominal aortic aneurysm (TAAA). We utilize spinal cord protection including cerebrospinal fluid drainage (CSFD), adjuncts of aortic distal perfusion, reconstruction of the intercostal or lumbar arteries and deep hypothermia in TAAA repair. This report describes the results of surgical treatment for TAAA including postoperative neurological outcome. Between October 1999 and January 2004, 33 patients (mean age 66 years; range 26 to 81) underwent TAAA repair. Adamkiewicz artery could be detected using magnetic resonance angiography in 9 patients. CSFD was done in 20 patients. TAAA repair was achieved using adjuncts of aortic distal perfusion in 31 patients (partial cardiopulmonary bypass: 19, deep hypothermia: 9, left heart bypass: 3). We tried to reconstruct the intercostal or lumbar arteries which were located between Th8 and L2 as possible. Twenty-five patients underwent reconstruction of the intercostal or lumbar arteries. There were 6 hospital deaths. Postoperative spinal cord injury occurred in 4 patients (paraparesis: 1, paraplegia: 3). This clinical experience demonstrates that current technical strategies enable patients to undergo TAAA repair with acceptable early survival. However, despite aggressive spinal cord protection, few patients suffered from postoperative spinal cord injury. Future research should focus on spinal cord protection in patients with TAAA.
Hanafusa
Y
Y
Division of Cardiovascular, Thoracic, and Pediatric Surgery, Kobe University, Graduate School of Medicine, Kobe, Japan.
Okada
K
K
Mimura
T
T
Kawanishi
Y
Y
Ozaki
N
N
Yamashita
T
T
Tsuji
Y
Y
Okita
Y
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002555:Cerebrospinal Fluid; D004322:Drainage; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010264:Paraplegia / Q000517:prevention & control*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply / Q000503:physiopathology; D020760:Spinal Cord Ischemia / Q000517:prevention & control*; D016896:Treatment Outcome