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Prevention of postoperative paraplegia during thoracoabdominal aortic surgery1  Yukio Kuniyoshi, MD, PhD, Kageharu Koja, MD, PhD, Kazufumi Miyagi, MD,

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Presentation on theme: "Prevention of postoperative paraplegia during thoracoabdominal aortic surgery1  Yukio Kuniyoshi, MD, PhD, Kageharu Koja, MD, PhD, Kazufumi Miyagi, MD,"— Presentation transcript:

1 Prevention of postoperative paraplegia during thoracoabdominal aortic surgery1 
Yukio Kuniyoshi, MD, PhD, Kageharu Koja, MD, PhD, Kazufumi Miyagi, MD, Mituyoshi Shimoji, MD, Tooru Uezu, MD, Katuya Arakaki, MD, Satoshi Yamashiro, MD, PhD, Katuhito Mabuni, MD, Shigenobu Senaha, MD, Yoshiyuki Nakasone, MD  The Annals of Thoracic Surgery  Volume 76, Issue 5, Pages (November 2003) DOI: /S (03)

2 Fig 1 The preservation of reimplanted segmental arteries with a tourniquet method. Purse string sutures using 3-0 monofilament sutures are placed around the ostia of segmental arteries (arrows) to act as tourniquets and arrest bleeding. This technique can preserve segmental arteries until completion of graft replacement. The Annals of Thoracic Surgery  , DOI: ( /S (03) )

3 Fig 2 Sequential aneurysm excision and graft replacement from the proximal to the distal end. Proximal anastomosis is performed (A). The distal clamp forceps is moved to a subsequent clamp site on the descending thoracic aorta, and as many intercostal arteries as can be found within these segments are reconstructed (B). Because a critical artery responsible for preventing spinal cord ischemia often branches off the aorta near the diaphragm, the celiac trunk and superior mesenteric arteries are perfused during critical artery reconstruction (C). The celiac and superior mesenteric arteries are reimplanted during perfusion. Finally, the clamp forceps is moved distal to the renal artery, which is reconstructed under perfusion (D and E). The Annals of Thoracic Surgery  , DOI: ( /S (03) )

4 Fig 3 Distribution of the reimplanted intercostal and lumbar arteries. Of the 124 reimplanted arteries, 90 (72.6%) were reconstructed between T9 and L2 (grey area). The Annals of Thoracic Surgery  , DOI: ( /S (03) )

5 Fig 4 Overall cumulative survival rate of patients undergoing thoracoabdominal aortic aneurysm surgery. Numbers of patients at risk are shown in parentheses. The Annals of Thoracic Surgery  , DOI: ( /S (03) )

6 Fig 5 Cumulative survival curves in dissecting (dashed line) and nondissecting (straight line) aneurysmal groups of thoracoabdominal aortic aneurysm. There is no difference in survival rates between the two groups. Numbers of patients at risk are shown in parentheses. The Annals of Thoracic Surgery  , DOI: ( /S (03) )

7 Fig 6 Case 46 was 66 years old with a Crawford type I thoracoabdominal aortic aneurysm. Graft replacement of the thoracoabdominal aortic aneurysm and reconstruction of T6, T8, T11, T12, and L1 were performed. Depicted is a postoperative arteriogram of the reconstructed 11th intercostal artery showing collateral flow (white arrow) to the upper intercostal artery (10th intercostal artery). (ASA = anterior spinal artery.) The Annals of Thoracic Surgery  , DOI: ( /S (03) )

8 The Annals of Thoracic Surgery 2003 76, 1477-1484DOI: (10
The Annals of Thoracic Surgery  , DOI: ( /S (03) )

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