Thoracic and Thoracoabdominal Aneurysm Repair: Is Reimplantation of Spinal Cord Arteries a Waste of Time? Christian D. Etz, MD, James C. Halstead, MA.

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Presentation transcript:

Thoracic and Thoracoabdominal Aneurysm Repair: Is Reimplantation of Spinal Cord Arteries a Waste of Time? Christian D. Etz, MD, James C. Halstead, MA (Cantab), MRCS, David Spielvogel, MD, Rohit Shahani, MD, Ricardo Lazala, MD, Tobias M. Homann, MS, Donald J. Weisz, PhD, Konstadinos Plestis, MD, Randall B. Griepp, MD The Annals of Thoracic Surgery Volume 82, Issue 5, Pages 1670-1677 (November 2006) DOI: 10.1016/j.athoracsur.2006.05.029 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Shown are motor evoked potentials (MEP) recorded in the right arm (RA), right leg (RL), left arm (LA), and left leg (LL) after transcranial electrical stimulation over the motor cortex. The patient had segmental artery sacrifice from T3 to L1. Baseline MEPs are shown in panel a. Each trace shows 100 ms activity after stimulation. The MEPs and somatosensory evoked potentials (SSEP [not shown]) were reduced in amplitude during a period of ischemia but never completely disappeared (panel b). After flow restoration, the MEPs had increased to well over 50% baseline (panel c). The patient’s postoperative motor strength was similar to its preoperative level. (B) Shown are SSEPs recorded at P’z (4 to 5 cm posterior to vertex) referenced to Fz (near to forehead) after stimulation of the posterior tibial nerve at the right ankle followed 100 ms later by stimulation of the posterior tibial nerve at the left ankle. The patient had segmental artery sacrifice from T6 through L2. Baseline SSEPs are shown at the top of the waterfall. Both the SSEPs and MEPs (not shown) were lost temporarily during a period of distal ischemia, but returned to baseline levels by the end of the operation (bottom of waterfall). The patient’s motor strength postoperatively was similar to its preoperative level. The Annals of Thoracic Surgery 2006 82, 1670-1677DOI: (10.1016/j.athoracsur.2006.05.029) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The graph displays the extent of segmental artery sacrifice between T7 and L1 in 100 patients with TAA/A. The number of patients who had each number of sacrificed vessels in this high-risk region is shown. (TAA/A = thoracic and thoracoabdominal aortic aneurysms.) The Annals of Thoracic Surgery 2006 82, 1670-1677DOI: (10.1016/j.athoracsur.2006.05.029) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The extent of segmental artery sacrifice in each of the 100 patients (operated on October 2002 to December 2004) is shown in chronologic order. Postoperative death (*) and paraplegia (**) are indicated. The Annals of Thoracic Surgery 2006 82, 1670-1677DOI: (10.1016/j.athoracsur.2006.05.029) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions