Staged procedures for prevention of spinal cord ischemia in endovascular aortic surgery

Gefässchirurgie : Zeitschrift für vaskuläre und endovaskuläre Chirurgie : Organ der Deutschen und der Österreichischen Gesellschaft für Gefässchirurgie unter Mitarbeit der Schweizerischen Gesellschaft für Gefässchirurgie
F HeidemannTilo Kölbel

Abstract

Spinal cord ischemia with development of paraplegia is the most relevant complication of thoracoabdominal aortic surgery caused by compromising the segmental arteries. To prevent this devastating complication in endovascular aortic surgery, staging procedures have been developed to reinforce collateral blood flood to the spinal cord. In patients with a medium to high risk for spinal cord ischemia, staged aortic repair is recommended. The classical staged repair is the two-step repair with delayed implantation of the aortic stent grafts. Additionally, more recent methods for short-term salvage of segmental artery perfusion by leaving an endoleak have been developed. Perfusion branches, delayed bridging stents as well as the open branch technique are among these methods. The latest option of staged repair is minimally invasive segmental artery embolization. Besides the nonsurgical options for monitoring and therapy of spinal cord ischemia, various staging procedures are available, which can be implemented depending on the patient and the aortic anatomy. Evidence that underlines staged repair for endovascular treatment of thoracoabdominal aortic pathologies is mostly based on retrospective studies.

References

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Citations

May 19, 2020·Cardiovascular and Interventional Radiology·Andrea MelloniLuca Bertoglio
Oct 15, 2020·Journal of Vascular Surgery·Anastasia PlotkinGregory A Magee
Mar 5, 2021·Seminars in Thoracic and Cardiovascular Surgery·D Alan Herbst, Pavan Atluri
Apr 9, 2021·Annals of Vascular Surgery·Carla Lorena Blanco AmilVincent Riambau
Sep 18, 2021·Journal of Neuropathology and Experimental Neurology·Hamdy AwadEsmerina Tili

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