A New Combined Technique Reducing the Risk of Paraplegia during Thoracoabdominal Aorta Replacement.

Details

Serval ID
serval:BIB_72D72D3DADD9
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
A New Combined Technique Reducing the Risk of Paraplegia during Thoracoabdominal Aorta Replacement.
Journal
The Thoracic and cardiovascular surgeon
Author(s)
Tozzi P., Pralong E., Gronchi F., Siniscalchi G.
ISSN
1439-1902 (Electronic)
ISSN-L
0171-6425
Publication state
Published
Issued date
03/2017
Peer-reviewed
Oui
Volume
65
Number
2
Pages
126-129
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Acute spinal cord ischemia during thoracoabdominal aorta replacement is a dreadful complication. Existing tools (motor evoked potential [MEP] and somatosensory evoked potential [SSEP]) do not allow differentiating between central and peripheral paraplegia. Therefore, the surgeon often performs unnecessary reimplantation of intercostal arteries: this is time consuming, and significantly increases bleeding complications. We present a simple technique combining MEP and peripheral compound muscle action potential induced by posterior tibialis nerve stimulation, enabling the surgeon to quickly discriminate between central and peripheral neurologic injury. The surgeon has one more tool to drive in real time the optimal surgical strategy. This strategy guides the decision as to which side branches ought to be reimplanted, thus minimizing the risk of paraplegia.

Keywords
Aorta, Thoracic/physiopathology, Aorta, Thoracic/surgery, Aortic Aneurysm, Thoracic/diagnosis, Aortic Aneurysm, Thoracic/physiopathology, Aortic Aneurysm, Thoracic/surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation/adverse effects, Blood Vessel Prosthesis Implantation/instrumentation, Blood Vessel Prosthesis Implantation/methods, Electric Stimulation, Evoked Potentials, Motor, Humans, Intraoperative Neurophysiological Monitoring/methods, Neuromuscular Monitoring, Paraplegia/diagnosis, Paraplegia/etiology, Paraplegia/physiopathology, Paraplegia/prevention & control, Predictive Value of Tests, Replantation, Risk Factors, Spinal Cord Ischemia/diagnosis, Spinal Cord Ischemia/etiology, Spinal Cord Ischemia/physiopathology, Spinal Cord Ischemia/prevention & control, Thoracic Arteries/surgery, Tibial Nerve, Trauma, Nervous System/diagnosis, Trauma, Nervous System/etiology, Trauma, Nervous System/physiopathology, Trauma, Nervous System/prevention & control, Treatment Outcome, Workflow
Pubmed
Web of science
Create date
17/04/2017 17:28
Last modification date
20/08/2019 14:30
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