title: [Spinal cord protection during thoracoabdominal aortic aneurysm repair; efficacy of distal aortic perfusion and segmental aortic clamping].
abstract: Despite improvement in adjuncts for thoracoabdominal aortic aneurysms (TAAA) repairs, many devastating complications remains after the surgery. Our experience with these aneurysms has been reviewed in order to identify those methods at risk of major morbidity, as well as which further improvements required. During last 16 years, 53 consecutive patients were operated on TAAA. The mean age was 58 years. Twenty patients had dissecting aneurysms and 13 patients had had prior aortic surgery. A femoro-femoral bypass was used to maintain distal aortic perfusion in most patients. Reimplantation of intercostal or lumbar arteries under the multi-segmental aortic clamping is consistent in our technique. Motor evoked potentials (MEP) were measured to monitor spinal cord protection since 2000. The hospital mortality was 9.4% (5/53), 22.2% (2/9) for emergency operation and 15.4% (2/13) for patients with prior aortic surgery. The mortality for the first and elective operations was 3.2% (1/31). No any neurologic dysfunction was observed in all patients including the hospital deaths. In view of clinical results, our adjuncts and techniques are useful for prevention of spinal cord ischemia during the TAAA surgery.
authors.affiliation: Second Department of Surgery, Faculty of Medicine, University of Ryukyu, Okinawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Koja
authors.forename: Y
authors.initials: Y
authors.lastname: Kuniyoshi
authors.forename: K
authors.initials: K
authors.lastname: Miyagi
authors.forename: T
authors.initials: T
authors.lastname: Uezu
authors.forename: K
authors.initials: K
authors.lastname: Arakaki
authors.forename: S
authors.initials: S
authors.lastname: Yamashiro
authors.forename: K
authors.initials: K
authors.lastname: Mabuni
authors.forename: T
authors.initials: T
authors.lastname: Nagano
authors.forename: E
authors.initials: E
authors.lastname: Senaha
authors.forename: M
authors.initials: M
authors.lastname: Kakinohana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003250:Constriction; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010477:Perfusion / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D020760:Spinal Cord Ischemia / Q000175:diagnosis / Q000517:prevention & control*