title: Somatosensory-evoked potential-guided intercostal artery reimplantation in thoracoabdominal aortic aneurysm surgery.
abstract: OBJECTIVE
  This study was undertaken to evaluate the use of somatosensory-evokedpotential (SSEP) monitoring on intercostal artery reimplantation (IAR) and spinal cord ischemia rates during thoracoabdominal ortic aneurysm repair.
  
  
  METHODS
  Fifty-two patients had thoracoabdominal aortic aneurysm repair with IAR under SSEP guidance and 79 patients had repair with routine IAR without SSEP guidance from 1999 to 2010.
  
  
  RESULTS
  No differences were observed between the two groups in age (63.1 ± 11.6 vs 64.8 ± 9.8 years), sex (57.7% vs 50.6% men), chronic dissections (40.4% vs 44.3%), renal insufficiency (11.5% vs 10.1%), and Crawford type 1 and 2 aneurysms (53.9% vs 53.9%). There was one case (1.9%) of immediate paraplegia and one case (1.9%) of delayed paraplegia in the SSEP group versus 2 cases (2.5%) of immediate paraplegia in the non-SSEP group (P = 0.92). In the SSEP group, 38 patients (73.1%) had SSEP changes, but only 15 (28.8%) required reimplantation. There were fewer IARs in the SSEP group compared with the non-SSEP group (28.8% vs. 59.5%, P = 0.004). No difference was observed in 30-day mortality between the SSEP and the non-SSEP group (3.9% vs. 7.6%, P = 0.48).
  
  
  CONCLUSIONS
  The use of SSEP monitoring led to a significant decrease in the need for IAR without increasing the paraplegia rate.
authors.affiliation: From the *University Hospital of Coventry and Warwickshire, Coventry, West Midlands, England; and †Aortic Wellness Center, Division of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore LIJ Health System, New York, NY USA.
authors.forename: Jain Bhaskara
authors.initials: JB
authors.lastname: Pillai
authors.forename: Yonni
authors.initials: Y
authors.lastname: Pellet
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulos
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Sadek
authors.forename: Djamila
authors.initials: D
authors.lastname: Abjigitova
authors.forename: David
authors.initials: D
authors.lastname: Weiss
authors.forename: Konstadinos A
authors.initials: KA
authors.lastname: Plestis
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007366:Intercostal Muscles / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D020335:Paraparesis / Q000517:prevention & control; D010264:Paraplegia / Q000517:prevention & control; D012039:Regional Blood Flow; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020760:Spinal Cord Ischemia / Q000517:prevention & control*; D013895:Thoracic Arteries / Q000637:transplantation*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods