Treatment of delayed neurological deficits after surgical repair of thoracic aortic aneurysm.
Delayed neurologic deficits, paraplegia and paraparesis, are devastating complications after repair of a descending thoracic and thoracoabdominal aortic aneurysm (TAAA). A treatment protocol has not been established, although strategies such as cerebrospinal fluid (CSF) drainage, maintaining blood pressure and medication have been described. Cerebrospinal drain status /oxygen delivery/patient status (COPS) therapy for delayed neurological deficit can improve spinal cord ischemia through reducing intraspinal pressure, improving oxygen delivery and maintaining high blood pressure. We describe one patient (Case 1), in whom descending thoracic and abdominal aortic aneurysms were treated by endovascular aortic repair, and another (Case 2) with Crawford type II TAAA, who developed delayed neurological deficits that were treated with immediate COPS therapy (Modified Tarlov scale; Case 1, improved from 2 to 4; Case 2, from 0 to 4). These findings indicate the benefit of COPS for treating delayed neurological deficits after descending thoracic and TAAA.
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University of Medicine, Sapporo, Hokkaido, Japan. yanasey@sapmed.ac.jp
Yohsuke
Y
Yanase
Nobuyoshi
N
Kawaharada
Toshiyuki
T
Maeda
Tetsuya
T
Koyanagi
Toshiro
T
Ito
Yoshihiko
Y
Kurimoto
Tetsuya
T
Higami
D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002395:Catecholamines / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004322:Drainage; D057510:Endovascular Procedures / Q000009:adverse effects*; D017707:Erythrocyte Transfusion; D006801:Humans; D008297:Male; D010102:Oxygen Inhalation Therapy; D020335:Paraparesis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D020760:Spinal Cord Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D002395:Catecholamines; D014662:Vasoconstrictor Agents