engleski

Spinal cord protection during thoracoabdominal aortic surgery

Background. Paraplegia is one of the most devastating complications after thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) surgery. Many protectivemeasures for prevention of the neurologic deficit have been devised. Although some of them improved operative results, the threat from paraplegia has not been eliminated. The purpose of this presentation is to review the methods for spinal cord protection, and to present our strategy. Methods. 6 TAA and 15 TAAA repairs were performed over the interval between 2006 and 2009. Surgical management included ‘‘clamp-and-sew’’ technique with CSF drainage in electively operated patients. ‘‘In-line’’ perfusion of superior mesenteric artery was used in two patients and temporary axillo-femoral bypass in three. Kidneys were protected by continuous perfusion with cold Ringer’s solution (40 C) during the procedure. Results. Two patients with ruptured aneurysms died due to multiorgan failure, and one with a symptomatic aneurysm died due to myocardial infarction. Paraplegia occurred in two subsequently deceased patients, while none of the surviving patients developed neurologic deficit. Conclusions. Although limited, the results of our case series support the selective use of adjuncts and individually tailored patient approach. This approach may produce acceptable results in dealing with this complex pathology even in centers with relatively limited volume of patients.

Spinal cord protection; Thoracoabdominal aortic surgery

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