Cerebrospinal dysfunction after endovascular stent-grafting via a median sternotomy: The frozen elephant trunk procedure
Cerebrospinal dysfunction after endovascular stent-grafting via a median sternotomy: The frozen elephant trunk procedure
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DOI：
10.1016/s0003-4975(02)04131-0
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发表时间：
2002-11-01
影响因子：
4.6
通讯作者：
Ueda, Y
中科院分区：
文献类型：
--
作者：
Usui, A;Fujimoto, K;Ueda, Y
背景通过正中胸骨切开术进行血管内支架移植术治疗远端弓状动脉瘤（冷冻象鼻手术）是合成移植物置换术的替代方法。但脊髓功能障碍很容易发生手术后的并发症。虽然其原因尚不确定，但已采取了一些预防措施。我们解决脊髓功能障碍的机制，并评估我们的预防措施的有效性。男22例，女2例，平均年龄71岁（59 ~ 83岁）。有22个真正的动脉瘤（13个梭形，9个囊状），一个慢性夹层，和一个穿透性主动脉溃疡。采用以下策略预防脊髓功能障碍：双侧腋动脉低流量灌注（n = 10）;猪尾导管引导（n = 19）;使用带锚定缝线的较短移植物（n = 12）;用二氧化碳充满术野（n = 7）;主动脉开放7例，采用超薄涤纶编织人工血管15例。无手术死亡率，但4例（17%）出现脑脊液功能障碍：1例截瘫，1例基底动脉沿着卒中，2例暂时性脊髓功能障碍（右腿感觉异常和排尿障碍）。脑脊髓功能障碍倾向于发生在梭形动脉瘤中（31%，p = 0.044）。除了通过双侧腋动脉进行低流量顺行灌注时，没有发生截瘫或下肢轻瘫（p = 0.064），用于预防脑脊液功能障碍的方法似乎没有什么效果。脑脊髓功能障碍是冷冻象鼻手术的严重并发症。其原因尚不清楚，但倾向于发生在梭形动脉瘤中。主动脉开放时，通过双侧腋动脉进行顺行灌注可能有助于预防。(C)2002年由胸外科医师协会出版。
Background. Endovascular stent grafting through a median sternotomy for a distal arch aneurysm (the frozen elephant trunk procedure) is an alternative to synthetic graft replacement. But spinal cord dysfunction can easily occur as a complication after surgery. Although its cause is uncertain, some attempts at prevention have been instituted. We address the mechanism of spinal cord dysfunction and evaluate the efficacy of our preventive measures.Methods. There were 22 men and 2 women with an average age of 71 (59 to 83) years. There were 22 true aneurysms (13 fusiform, nine saccular), one chronic dissection, and one penetrating aortic ulcer. The following strategies for prevention of spinal cord dysfunction were utilized: low flow perfusion through both axillary arteries (n = 10); pigtail catheter guidance (n = 19); use of a shorter graft with anchoring sutures (n = 12); flooding of the operative field with carbon dioxide (n = 7); aortic unclamping (n = 7), and use of ultra-thin woven Dacron grafts (n = 15).Results. There was no operative mortality, but cerebrospinal dysfunction complicated four cases (17%): one paraplegia, one stroke along the basilar artery, and two cases of temporary spinal cord dysfunction (paresthesia of the right leg and urinary disturbance). Cerebrospinal dysfunction tended to occur in fusiform aneurysms (31%, p = 0.044). Except when low flow antegrade perfusion through both the axillary arteries was utilized, which resulted in no cases of paraplegia or paraparesis (p = 0.064), the methods used for prevention of cerebrospinal dysfunction appeared to have little efficacy.Conclusions. Cerebrospinal dysfunction is a serious complication of the frozen elephant trunk procedure. Its cause has not been clarified, but it tends to occur in fusiform-type aneurysms. Antegrade perfusion through both axillary arteries while the aorta is open may be helpful in its prevention. (C) 2002 by The Society of Thoracic Surgeons.