New insights into spinal cord ischaemia after thoracic aortic procedures: the importance of the number of anterior radiculomedullary arteries for surgical outcome
New insights into spinal cord ischaemia after thoracic aortic procedures: the importance of the number of anterior radiculomedullary arteries for surgical outcome
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DOI：
10.1093/ejcts/ezy058
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发表时间：
2018-07-01
影响因子：
3.4
通讯作者：
Beyersdorf, Friedhelm
中科院分区：
文献类型：
--
作者：
Kari, Fabian A.;Saravi, Babak;Beyersdorf, Friedhelm
目的：前根髓质动脉（ARMA）连接背段动脉和脊髓侧支网络的椎管内室。胸部阿尔马的数量是高度可变的，从一个人到另一个。胸主动脉手术期间ARMA数量对脊髓灌注的影响尚不清楚。我们研究了胸ARMA的数量对脊髓灌注的影响，在主动脉外科大动物model.METHODS：26猪包括（20治疗动物，6假手术动物，体重34 +/- 3公斤）。在常温下，通过左侧胸廓切开术结扎动物的左锁骨下动脉和胸段动脉。处死后，用有色铸塑树脂进行全身灌注，并在尸检时记录胸部ARMA的数量。终点为脊髓灌注压、脑脊液压、脊髓血流量（微球）和神经学结局。结果：胸段ARMA数目为3（n = 1）~ 13（n = 1）。平均数为8。根据胸部阿尔马数量对动物进行分组：6-7（5只动物）、8-10（8只动物）和11-13（5只动物）。大量胸部ARMA与（i）从基线到钳夹后脊髓血流量下降较低，（ii）钳夹后3小时明显充血的存在和程度增加有关（P < 0.001）和（iii）在具有11个或更多阿尔马的动物中，在钳夹后立即开始存在早期充血（P < 0.001）。结论：我们发现，在降主动脉外科手术中，大量的胸部阿尔马可以保护脊髓免受损伤。1
OBJECTIVES: Anterior radiculomedullary arteries (ARMAs) link dorsal segmental arteries and the intraspinal compartment of the spinal collateral network. The number of thoracic ARMA is highly variable from one person to another. The impact of the number of ARMAs on spinal cord perfusion during thoracic aortic procedures is unknown. We investigated the influence of the number of thoracic ARMAs on spinal cord perfusion in an aortic surgical large animal model.METHODS: Twenty-six pigs were included (20 treatment animals, 6 sham animals, weight 34 +/- 3 kg). The animals underwent ligation of the left subclavian artery and the thoracic segmental arteries via a left lateral thoracotomy with normothermia. After sacrifice, complete body perfusion with coloured cast resin was performed and the number of thoracic ARMAs was documented at autopsy. End points were spinal cord perfusion pressure, cerebrospinal fluid pressure, spinal cord blood flow (microspheres) and neurological outcome. Observation time was 3 h post-ligation.RESULTS: The numbers of thoracic ARMAs ranged between 3 (n = 1) and 13 (n = 1). The mean number was 8. Animals were grouped according to number of thoracic ARMA: 6-7 (5 animals), 8-10 (8 animals) and 11-13 (5 animals). A large number of thoracic ARMAs was linked to (i) a lower drop in spinal cord blood flow from baseline to post-clamp, (ii) the presence and increased magnitude of hyperaemia evident 3 h post-clamp (P < 0.001) and (iii) the presence of early hyperaemia starting immediately post-clamp in animals with 11 or more ARMA (P < 0.001).CONCLUSIONS: We showed that a large number of thoracic ARMA protects against spinal cord injury during descending aortic surgical procedures.1