scholarly journals Spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms with fenestrated and branched stent grafts

2015 ◽  
Vol 62 (6) ◽  
pp. 1450-1456 ◽  
Author(s):  
Athanasios Katsargyris ◽  
Kyriakos Oikonomou ◽  
George Kouvelos ◽  
Hermann Renner ◽  
Wolfgang Ritter ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
Aortic Aneurysms ◽  
Stent Grafts

scholarly journals Temporary Perfusion Branches to Decrease Spinal Cord Ischemia in the Endovascular Treatment of Thoraco-Abdominal Aortic Aneurysms

Aorta ◽  
2015 ◽  
Vol 03 (02) ◽  
pp. 56-60 ◽  
Author(s):  
Parveen Jayia ◽  
Jason Constantinou ◽  
Hamish Hamilton ◽  
Krassi Ivancev
Keyword(s):  
Spinal Cord ◽  
New York ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Complete Exclusion

Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA) Background: Spinal cord ischemia (SCI) is one of the most feared complications following the repair of thoraco- abdominal aortic aneurysms (TAAA). Endovascular repair of TAAA is now possible with branched stent grafts, but spinal cord ischaemia rates are still unacceptably high. A number of techniques have been utilized to reduce these levels, however, SCI remains a challenge to endovascular repair of TAAA. The use of sac perfusion branches aims to reduce the incidence of this catastrophic complication. Methods: A retrospective analysis of all patients undergoing branched endovascular aortic repair for all thoraco-abdominal aneurysms (TAAA) using custom made devices during January 2008 to August 2014. We describe a two staged technique in which perfusion of segmental vessels is maintained by a temporary endoleak through an open perfusion branch, incorporated within the branched stent graft, followed by a closure of this branch at a later date to complete exclusion of the aneurysm. Results: Forty-seven patients underwent TAAA repair. Twenty-five (53%) had a two-stage procedure using either a sac perfusion branch or a target vessel to perfuse the sac. Nine patients (19.15%) suffered some form of SCI with eight patients having temporary SCI (lasting less than 72 hours) and one patient having permanent SCI. Of eight patients that had temporary spinal cord ischemia, all had a perfusion strategy. There was one case of permanent SCI (2.13%). Conclusion: Sac perfusion branches provide a safe method for preventing SCI, however this needs to be used in conjunction with controlling MAP and CSF drainage.

Spinal Cord Ischemia following Elective Endovascular Repair of Infrarenal Aortic Aneurysms: A Systematic Review

2018 ◽  
Vol 52 ◽  
pp. 280-291 ◽  
Author(s):  
Konstantinos G. Moulakakis ◽  
Vangelis G. Alexiou ◽  
Georgios Karaolanis ◽  
George S. Sfyroeras ◽  
Georgios N. Theocharopoulos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
Aortic Aneurysms

Total Endovascular Repair With Parallel Stent-Grafts for Postdissection Thoracoabdominal Aneurysm After Prior Proximal Repair

2019 ◽  
Vol 26 (5) ◽  
pp. 668-675 ◽  
Author(s):  
Junjun Liu ◽  
Zhenjiang Li ◽  
Jiaxuan Feng ◽  
Jian Zhou ◽  
Zhiqing Zhao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Endovascular Therapy ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Type I ◽  
Type Ii ◽  
Technical Success ◽  
Stent Grafts

Purpose: To evaluate the safety and efficacy of total endovascular repair with parallel stent-grafts for postoperative residual dissection thoracoabdominal aortic aneurysm (TAAA). Materials and Methods: A retrospective study was undertaken of 21 patients (mean age 64.0±12.5 years; 17 men) undergoing total endovascular therapy with parallel stent-grafts for postdissection TAAA after prior proximal repair between 2014 and 2016. The preoperative minimum true lumen diameter was 12.3±4.8 mm and the mean extent of dissection was 248.1±48.2 mm. Pre-, intra-, and postoperative medical records were reviewed to assess technical success, spinal cord ischemia, patency of target branch arteries, endoleak, and short-term outcomes of this approach. Results: Technical success was achieved in 17 of 21 patients owing to 4 type I endoleaks at the end of the procedures. A total of 70 branch arteries were revascularized and 14 celiac trunks were covered intentionally without reconstruction. Of 7 intraoperative endoleaks, 2 were managed intraoperatively and 5 (4 type I and 1 type II) disappeared spontaneously within 1 month. No spinal cord or abdominal organ or limb ischemia was observed. Mean follow-up was 16.2±6.1 months. No death or type I or III endoleak occurred during the follow-up; 2 type II endoleaks were observed. Nineteen of the 21 false lumens thrombosed, and the total aortic diameter decreased (57.3±8.4 to 55.3±7.4 mm, p<0.01). Three (4.3%) of 70 target branch arteries occluded during follow-up. The cumulative patency of retrogradely and antegradely revascularized branch arteries was 97.3% vs 100% at 12 months and 91.2% vs 100% at 18 months. Conclusion: Total endovascular therapy with parallel stent-grafts could be an effective alternative in treating postdissection TAAA. Further studies with long-term follow-up and larger sample size are recommended to evaluate the technique.

scholarly journals Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms

2015 ◽  
Vol 61 (6) ◽  
pp. 1408-1416 ◽  
Author(s):  
Theodosios Bisdas ◽  
Giuseppe Panuccio ◽  
Masayuki Sugimoto ◽  
Giovanni Torsello ◽  
Martin Austermann
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
Aortic Aneurysms

scholarly journals VESS1. Risk Factors for Spinal Cord Ischemia After Endovascular Repair of Thoracoabdominal Aortic Aneurysms

2015 ◽  
Vol 61 (6) ◽  
pp. 4S
Author(s):  
Giuseppe Panuccio ◽  
Theodosios Bisdas ◽  
Giovanni Torsello ◽  
Martin J. Austermann
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
Aortic Aneurysms

“Awake” Spinal Cord Monitoring Under Local Anesthesia and Conscious Sedation in Fenestrated and Branched Endovascular Aortic Repair

2021 ◽  
pp. 152660282110282
Author(s):  
Said Abisi ◽  
Liam Musto ◽  
Oliver Lyons ◽  
Michelle Carmichael ◽  
Morad Sallam ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Length Of Stay ◽  
Local Anesthesia ◽  
Endovascular Repair ◽  
Conscious Sedation ◽  
Spinal Cord Ischemia ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Spinal Drain

Introduction Endovascular repair of thoracoabdominal aortic aneurysms carries a risk of spinal cord ischemia, the causes of which remain uncertain. We hypothesized that local anesthesia (LA) with conscious sedation could abrogate the potential suppressive cardiovascular effects of general anesthesia (GA) and facilitate intraoperative monitoring of neurological function. Here, we examine the feasibility of this technique during fenestrated (FEVAR) or branched endovascular aortic repair (BEVAR). Materials and Methods Consecutive patients undergoing FEVAR or BEVAR under LA and conscious sedation by a team at a single center were analyzed. Patients received conscious sedation using intravenous remifentanil and propofol infusions in conjunction with a local anesthetic agent. No patient had a prophylactic spinal drain inserted. Outcome measures included conversion to GA, need for vasopressors and/or spinal drainage, length of stay, complications, and patient survival. Results A total of 44 patients underwent FEVAR or BEVAR under LA and conscious sedation. The cohort included thoracoabdominal aortic aneurysms (n=41) and pararenal aneurysms treated with endografts covering the supraceliac segment (n=3). Four patients (9%) required conversion to GA at a median operative duration of 198 minutes (range 97–495 minutes). Vasopressors were required intraoperatively in 3 of the cases that were converted to GA. No patient developed spinal cord ischemia and none had insertion of a spinal drain. The median hospital length of stay was 4 days (range 2–41 days). Postoperative delirium and hospital-acquired pneumonia was seen in 7% of patients. All patients survived to 30 days, with 95% alive at a median follow-up of 15 months (range 3–26 months). Conclusion LA and conscious sedation is a feasible anesthetic technique for the endovascular repair of thoracoabdominal aortic aneurysms.

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