scholarly journals Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Mohamed Abd El-Monem Abd El-Salam Rizk ◽  
Mohamed Ismail Mohamed Ismail ◽  
Kareem Sabry Gohar
Keyword(s):  
Spinal Cord ◽  
Subclavian Artery ◽  
Upper Limb ◽  
Left Subclavian Artery ◽  
Spinal Cord Ischemia ◽  
Case Series ◽  
Limb Ischemia ◽  
Spinal Fluid ◽  
Case Series Study ◽  
Sealing Zone

Abstract Background We performed routine spinal fluid drainage for patients who underwent TEVAR for thoracic aortic pathology together with left subclavian artery coverage, which was needed for achievement of a safe proximal sealing zone. We assessed the occurrence of spinal cord ischemia as well the rate of occurrence of other complications such as stroke, and upper limb ischemia. Results This was a case series study done between July 2014 and April 2020, in them all the left subclavian artery was covered to ensure a proximal safe seal zone. Routine spinal fluid drainage was done, keeping the spinal fluid pressure < 10–15 mmHg with catheter in place for 48 h. Data was obtained from twenty-three patients who underwent TEVAR for thoracic aortic dissection (73.91%), thoracic aortic aneurysm (21.74%), or ulcer (4.35%). Planning was based upon multi-slice computed tomographic angiography and covering the left subclavian was mandatory to achieve a proximal sealing zone. Technical success was achieved in 100% of cases. 4.35% of patients had three endograft, 56.52% had two endografts, 39.13% had one endograft. All patients lost their radial pulsations immediately after implantation, 8.70% developed post implantation syndrome(fever) that was managed conservatively, 4.35% developed stroke related to the anterior circulation, 4.35% developed signs of spinal cord ischemia. During the follow up, one patient died within 6 h after the procedure due to extensive myocardial infarction (patient was scheduled for CABG after our procedure). 17.40% developed upper limb symptoms that were tolerable and were managed conservatively. Conclusion By adopting routine spinal cord drainage and pressure monitoring, we can consider not to revascularize the left subclavian artery prior to TEVAR if it will be covered.

Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis

Vascular ◽  
2017 ◽  
Vol 25 (6) ◽  
pp. 587-597 ◽  
Author(s):  
Pedro GR Teixeira ◽  
Karen Woo ◽  
Adam W Beck ◽  
Salvatore T Scali ◽  
Fred A Weaver ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Subclavian Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Left Subclavian Artery ◽  
Spinal Cord Ischemia ◽  
Multivariable Analysis ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011–July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences. Results The left subclavian artery was covered in 508 (24.6%) of the 2063 thoracic endovascular aortic repairs performed. Among patients with left subclavian artery coverage, 58.9% underwent revascularization. Spinal cord ischemia incidence was 12.1% in the group without revascularization compared to 8.5% in the group undergoing left subclavian artery revascularization (odds ratio (95%CI): 1.48(0.82–2.68), P = 0.189). Multivariable analysis adjustment identified an independent association between left subclavian artery coverage without revascularization and the incidence of spinal cord ischemia (adjusted odds ratio (95%CI): 2.29(1.03–5.14), P = 0.043). Although the incidence of stroke was also higher for the group with a covered and nonrevascularized left subclavian artery (12.1% versus 8.5%), this difference was not statistically significant after multivariable analysis (adjusted odds ratio (95%CI): 1.55(0.74–3.26), P = 0.244). Conclusion For patients undergoing left subclavian artery coverage during thoracic endovascular aortic repair, the addition of a revascularization procedure was associated with a significantly lower incidence of spinal cord ischemia.

scholarly journals Left Subclavian Artery Revascularization in Thoracic Endovascular Aortic Repair: Single Center’s Clinical Experiences From 171 Patients

2021 ◽  
Author(s):  
Wei Xie ◽  
Yunxing Xue ◽  
Shuchun Li ◽  
Min Jin ◽  
Qing Zhou ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Subclavian Artery ◽  
Retrospective Cohort ◽  
Left Subclavian Artery ◽  
Spinal Cord Ischemia ◽  
Survival Rates ◽  
Thoracic Endovascular Aortic Repair ◽  
Clinical Experiences ◽  
Extremity Ischemia

Abstract Background: Left subclavian artery revascularization (LSA) is frequently performed in the setting of thoracic endovascular repair (TEVAR). The purpose of this study was to compare different techniques for LSA revascularization during TEVAR.Methods: We performed a single center’s retrospective cohort study from 2016 to 2019. Patients were categorized by LSA revascularization methods, including direct coverage without revascularization (Unrevascularized), carotid-subclavian bypass (CSB), fenestrated TEVAR (F-TEVAR). Indications, demographics, operation details, and outcomes were analyzed using standard statistical analysis.Results: 171 patients underwent TEVAR with LSA coverage, 16.4% (n=28) were unrevascularized and the remaining patients underwent CSB (n=100 [58.5%]) or F-TEVAR (n=43 [25.1%]). Demographics were similar between the unrevascularized and revascularized groups, except for procedure urgent status (p = 0.005). The incidence of postoperative spinal cord ischemia was significantly higher between unrevascularized and revascularized group (10.7% vs 1.4%; p = 0.032). There was no difference in 30-day and mid-term rates of mortality, stroke, and left upper extremity ischemia. CSB was more likely time-consuming than F-TEVAR [3.25 (2.83 - 4) vs 2 (1.67 – 2.67) hours, p = 0], but there were no statistically significant differences in 30-day or midterm outcomes for CSB vs F-TEVAR. During a mean follow-up time of 24.8 months, estimates survival rates had no difference.Conclusions: LSA revascularization in zone 2 TEVAR is necessary which is associated with a low 30-day rate of spinal cord ischemia. When LSA revascularization is required during TEVAR, CSB and F-TEVAR are all safe and effective methods, and F-TEVAR appears to offer equivalent clinical outcomes as a less time-consuming and minimally invasive alternative.

scholarly journals Left subclavian artery revascularization in thoracic endovascular aortic repair: single center’s clinical experiences from 171 patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Wei Xie ◽  
Yunxing Xue ◽  
Shuchun Li ◽  
Min Jin ◽  
Qing Zhou ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Subclavian Artery ◽  
Retrospective Cohort ◽  
Left Subclavian Artery ◽  
Spinal Cord Ischemia ◽  
Survival Rates ◽  
Thoracic Endovascular Aortic Repair ◽  
Clinical Experiences ◽  
Extremity Ischemia

Abstract Background Left subclavian artery revascularization (LSA) is frequently performed in the setting of thoracic endovascular repair (TEVAR). The purpose of this study was to compare different techniques for LSA revascularization during TEVAR. Methods We performed a single center’s retrospective cohort study from 2016 to 2019. Patients were categorized by LSA revascularization methods, including direct coverage without revascularization (Unrevascularized), carotid-subclavian bypass (CSB), fenestrated TEVAR (F-TEVAR). Indications, demographics, operation details, and outcomes were analyzed using standard statistical analysis. Results 171 patients underwent TEVAR with LSA coverage, 16.4% (n = 28) were unrevascularized and the remaining patients underwent CSB (n = 100 [58.5%]) or F-TEVAR (n = 43 [25.1%]). Demographics were similar between the unrevascularized and revascularized groups, except for procedure urgent status (p = 0.005). The incidence of postoperative spinal cord ischemia was significantly higher between unrevascularized and revascularized group (10.7% vs. 1.4%; p = 0.032). There was no difference in 30-day and mid-term rates of mortality, stroke, and left upper extremity ischemia. CSB was more likely time-consuming than F-TEVAR [3.25 (2.83–4) vs. 2 (1.67–2.67) hours, p = 0], but there were no statistically significant differences in 30-day or midterm outcomes for CSB versus F-TEVAR. During a mean follow-up time of 24.8 months, estimates survival rates had no difference. Conclusions LSA revascularization in zone 2 TEVAR is necessary which is associated with a low 30-day rate of spinal cord ischemia. When LSA revascularization is required during TEVAR, CSB and F-TEVAR are all safe and effective methods, and F-TEVAR appears to offer equivalent clinical outcomes as a less time-consuming and minimally invasive alternative.

Hybrid versus in vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 42-47
Author(s):  
Maohua Wang ◽  
Dianning Dong ◽  
Hai Yuan ◽  
Mo Wang ◽  
Xuejun Wu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Landing Zone ◽  
Procedural Success

Purpose To compare hybrid and in vitro fenestration procedures for preserving the left subclavian artery in thoracic endovascular aortic repair (TEVAR) with unfavorable proximal landing zone. Methods Retrospective comparison of data from 49 consecutive patients who underwent left subclavian artery revascularization during TEVAR by either hybrid or fenestration approaches from January 2015 to March 2018. Procedural duration, and 30-day rates of procedural success, mortality and complications (endoleaks, cerebral infarction, spinal cord ischemia, left arm ischemic symptoms, and delirium) were compared. Results For hybrid procedure ( n = 32) vs. fenestration ( n = 17) groups, which were age and gender matched: procedural success rate was 100%, with significantly longer procedural duration (248.4 ± 40.9 vs. 60.6 ± 16.8 min; t = –22.653, P = 0.000) and similar 30-day complication rate (18.8% vs. 11.8%; χ2 = 0.397, P = 0.529). At 12.7 ± 9.3 months’ follow-up, there were no cases of death, spinal cord ischemia, or other complications in either group. Conclusions In this retrospective, single-center comparison, both hybrid and in vitro fenestration approaches for reconstructing the left subclavian artery in TEVAR with unfavorable proximal landing zone appeared safe and effective, with shorter procedural duration for fenestration. Larger studies with longer term follow-up are warranted.

scholarly journals RR24. Association of Left Subclavian Artery Coverage Without Revascularization and Spinal Cord Ischemia in Patients Undergoing TEVAR

2015 ◽  
Vol 61 (6) ◽  
pp. 201S
Author(s):  
Pedro G. Teixeira ◽  
Karen Woo ◽  
Adam W. Beck ◽  
Salvatore T. Scali ◽  
Fred A. Weaver
Keyword(s):  
Spinal Cord ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Spinal Cord Ischemia

The case for skin camouflage in the management of upper limb scarring – A case series

Hand Therapy ◽  
2021 ◽  
pp. 175899832110078
Author(s):  
Laura Adamson ◽  
Anna Selby
Keyword(s):  
Upper Limb ◽  
Case Series ◽  
Primary Objective ◽  
Self Confidence ◽  
Published Evidence ◽  
Case Series Study ◽  
Visual Impact ◽  
Series Study ◽  
Increasing Function

Introduction For some people the appearance of their hands is as important as function. Upper limb scarring can cause some patients distress. Skin camouflage is an intervention that can be used to reduce the visual impact of a scar but there is limited published evidence for its use for hand scarring. Methods This is a case series study with a primary objective to determine whether skin camouflage reduces distress in patients with an upper limb scar and to evaluate this new service. Patients experiencing distress from an upper limb scar were recruited from a hand therapy outpatient clinic. The intervention delivered was a one hour skin camouflage session. Photographs of the upper limb pre and post skin camouflage intervention were taken. The patient-rated Michigan Hand Questionnaire (MHQ) and Derriford Appearance Scale (DAS24) were completed before treatment, at 1 week and 1 month after treatment. Results Six participants reporting distress from an upper limb scar received skin camouflage intervention. Only three out of six participants completed all follow-up. All three showed improvement in at least two domains of the MHQ (function and aesthetics) at one month post treatment. Increased confidence during functional and work-based activities was also reported on the DAS24. Participants reported increased engagement in daily activities as a result of being able to camouflage their scars. Conclusions This small case series shows that skin camouflage intervention may be beneficial for some patients who are experiencing distress related to an upper limb scar by increasing function and self-confidence.

scholarly journals Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110040
Author(s):  
Kuen Su Lee ◽  
Yoo Kyung Jang ◽  
Gene Hyun Park ◽  
In Jae Jun ◽  
Jae Chul Koh
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Therapeutic Potential ◽  
Case Series ◽  
Limb Amputation ◽  
Intractable Pain ◽  
Limb Pain ◽  
Cord Injury ◽  
Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

scholarly journals Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affecter Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability. Case Series

2020 ◽  
Author(s):  
Rocío Palomo-Carrión ◽  
Rita-Pilar Romero-Galisteo ◽  
Elena Piñero-Pinto ◽  
Purificación López-Muñoz ◽  
Helena Romay-Barrero ◽  
...  
Keyword(s):  
Upper Limb ◽  
Case Series ◽  
Movement Therapy ◽  
Low Intensity ◽  
Constraint Induced Movement Therapy ◽  
Case Series Study ◽  
Quality Of Movement ◽  
Prospective Case Series ◽  
Quest Scale

Objective: To assess the functionality of the affected upper limb in children diagnosed with hemiplegia aged between 4 and 8 years after applying low-intensity modified constraint-induced movement therapy(mCIMT). Methods: Prospective case series study. A mCIMT protocol was applied for five weeks, with two hours of containment per day. The study variables were: quality of movement of the upper limb, spontaneous use, participation of the affected upper limb in activities of daily living, dynamic joint position, grasp-release action, grasp strength, supination and extension elbow movements. Four measurements were performed, using the QUEST scale, the SHUEE Evaluation, a hand dynamometer and a goniometer. Results: The sample was composed of 8 children with moderate manual ability. Statistically significant differences were detected in all the studied variables (p&amp;lt;0.05). The greatest increase occurred in spontaneous use from assessment 1-4 (p = 0.01), reaching 88.87% active participation in bimanual tasks. The quality of movement of the upper limb obtained a significant value due to the increase in dissociated movements and grasp (p = 0.01). Conclusion: A low dose (50 hours) of mCIMT increased the functionality of children diagnosed with congenital hemiplegia between 4 and 8 years of age with moderate manual ability.

scholarly journals Immunohistochemical Analysis of the Spinal Cord Ischemia– Effect of Remote Ischemic Preconditioning in a Porcine Model

2018 ◽  
Vol 21 (3) ◽  
pp. 209 ◽  
Author(s):  
Henri Johannes Haapanen ◽  
Johanna Herajärvi ◽  
Hannu-Pekka Honkanen ◽  
Caius Mustonen ◽  
Hannu Tuominen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Ischemic Preconditioning ◽  
Neuroprotective Effect ◽  
Spinal Cord Ischemia ◽  
Immunohistochemical Analysis ◽  
Limb Ischemia ◽  
Remote Ischemic Preconditioning ◽  
Control Group ◽  
Segmental Artery

Background: In experimental settings, remote ischemic preconditioning (RIPC) has shown a positive effect regarding spinal cord protection after local ischemia. In this study, we conducted spinal cord immunohistochemistry to demonstrate the protective effect of RIPC after 24 hours of the regional ischemia. Methods: Twenty piglets were randomized into an RIPC group (n = 10) and a control group (n = 10). The RIPC group underwent transient left hind limb ischemia before systematic left subclavian artery and segmental artery occlusion at the level of the diaphragm. Twenty-four hours later, the thoracic and lumbar spinal cords were harvested, and the oxidative stress markers were immunohistochemically analysed. Results: A total of 18 animals survived the 4-hour follow up (10 in the RIPC group, 8 in the control group) and 14 animals survived the 24-hour follow up (7 in each group). In the single sections of the spinal cord, the antioxidant pathway activation was seen in the RIPC group, as OGG1 and DJ-1/PARK7 activation was higher (P = .038 and P = .047, respectively). Conclusions: The results indicate that the neuroprotective effect of RIPC on the spinal cord after local ischemic insult remains controversial.

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