Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: The collateral network concept
Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: The collateral network concept
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DOI：
10.1016/j.athoracsur.2006.10.092
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发表时间：
2007-02-01
影响因子：
4.6
通讯作者：
Griepp, Eva B.
中科院分区：
文献类型：
--
作者：
Griepp, Randall B.;Griepp, Eva B.
在过去的二十年中，随着越来越多的胸降动脉瘤和胸腹动脉瘤患者被诊断和治疗，对脊髓灌注的更复杂的理解对于尽量减少脊髓损伤的频率变得重要。综合实验室研究和临床经验的信息，产生了侧枝网络概念，这是一个了解脊髓灌注的框架，从而在治疗左锁骨下动脉远端主动脉动脉瘤性疾病期间改善脊髓保护。基于侧支网络概念的原则的应用导致脊髓损伤的发生率下降，目前在降胸动脉瘤切除术中接近1%，在广泛胸腹切除术中不到10%。这些成果表明，通过进一步的研究，常规牺牲节段性主动脉分支可以在没有神经损伤的情况下进行手术和血管内治疗广泛远端动脉瘤。
In the last two decades, as an increasing number of patients with descending thoracic and thoracoabdominal aneurysms are being diagnosed and treated, a more sophisticated understanding of spinal cord perfusion has become important in the attempt to minimize the frequency of spinal cord injury. The synthesis of information from laboratory studies and clinical experience has led to the collateral network concept, a framework for understanding spinal cord perfusion and thereby improving spinal cord protection during treatment of aneurysmal disease of the aorta distal to the left subclavian artery. Application of principles based on the collateral network concept has resulted in falling rates of spinal cord injury, which now approach 1% in descending thoracic aneurysm resection and less than 10% in extensive thoracoabdominal resections. These accomplishments suggest that, with further investigation, routine sacrifice of segmental aortic branches can be carried out in a way that will allow surgical and endovascular therapy of extensive distal aortic aneurysms without neurologic injury.