Spinal cord protection in open- and endovascular thoracoabdominal aortic aneurysm repair: critical review of current concepts and future perspectives.
Spinal cord protection in open- and endovascular thoracoabdominal aortic aneurysm repair: critical review of current concepts and future perspectives.
复制标题
开放式和血管内胸腹主动脉瘤修复中的脊髓保护：对当前概念和未来前景的严格审查。
DOI：
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发表时间：
2015
影响因子：
1.4
通讯作者：
C. Etz
中科院分区：
文献类型：
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作者：
K. von Aspern;M. Luehr;F. Mohr;C. Etz
自主动脉手术开始半个多世纪以来，脊髓损伤（SCI）仍然是广泛开放和血管内胸腹主动脉瘤（TAA/ a）修复后最具破坏性的并发症。在过去的十年中，对脊髓灌注的广泛研究使我们对脊髓动脉供应中断的先前未知的生理机制有了更好的了解，而脊髓损伤的不断发展也强调了在TAA/ a修复期间和之后的治疗策略和监测方法方面需要新的概念。基于这些知识，新的治疗策略，特别是分期修复被开发出来。这一想法的首次人体翻译刚刚发表，介绍了新概念：微创选择性节段性动脉线圈栓塞。另一种克服降主动脉或胸腹主动脉支架置放导致的节段性动脉闭塞后最关键的初始阶段的方法是临时动脉瘤囊灌注，该方法最近也进行了临床试验。此外，一种新的无创实时监测方法也被提出，通过近红外光谱法记录脊髓旁侧支网络的脊髓活力，并成功地在临床环境中引入了试点系列。本文综述了这三个新概念存在的问题、未解决的问题和未来的展望。
Unresolved for over half a century now since the beginning of aortic surgery spinal cord injury (SCI) remains the most devastating complication after extensive open and endovascular thoracoabdominal aortic aneurysm (TAA/A) repair. Over the past decade extensive research on spinal cord perfusion lead to a better understanding of previously unknown physiologic mechanisms involved in the suspension of the cord's arterial supply and the consecutive development of SCI underscoring the need for new concepts in treatment strategy and monitoring methods during and after TAA/A repair. Based on this knowledge, new treatment strategies in particular the staged-repair were developed. The first-in-man translation of this idea has just been published introducing the new concept: minimally invasive selective segmental artery coil-embolization. Another approach to overcome the most critical initial period after segmental artery occlusion due to stent graft deployment in the descending or thoracoabdominal aorta is temporary aneurysm sac perfusion, which also has recently been clinically trialed. Furthermore, the new non-invasive real-time monitoring method to record spinal cord viability by means of near-infrared spectroscopy of the paraspinal collateral network by means of near-infrared spectroscopy has also been suggested and successfully introduced in a pilot series to a clinical setting. This review addresses problems, unsolved questions and future perspectives regarding these three new concepts.