Download PDF
Thorac Cardiovasc Surg 2017; 65(02): 126-129
DOI: 10.1055/s-0036-1579700
How to do it
Georg Thieme Verlag KG Stuttgart · New York

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

Piergiorgio Tozzi
1   Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
,
Etienne Pralong
2   Département de Neurosciences Cliniques, Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
,
Fabrizio Gronchi
3   Departement des Services de Chirurgie et Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, VD, Switzerland
,
Giuseppe Siniscalchi
1   Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
› Author Affiliations
Further Information

Publication History

10 December 2015

03 February 2016

Publication Date:
06 April 2016 (online)

    Permissions and Reprints All articles of this category

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/aortic - spinal cord - surgery - complications - neurology/neurologic
 

  • References

  • 1 Etz CD, Weigang E, Hartert M , et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery. Eur J Cardiothorac Surg 2015; 47 (6) 943-957
    CrossrefPubMedSearch in Google Scholar
  • 2 Meylaerts SA, Jacobs MJ, van Iterson V, De Haan P, Kalkman CJ. Comparison of transcranial motor evoked potentials and somatosensory evoked potentials during thoracoabdominal aortic aneurysm repair. Ann Surg 1999; 230 (6) 742-749
    CrossrefPubMedSearch in Google Scholar
  • 3 Augoustides JG, Stone ME, Drenger B. Novel approaches to spinal cord protection during thoracoabdominal aortic interventions. Curr Opin Anaesthesiol 2014; 27 (1) 98-105
    CrossrefPubMedSearch in Google Scholar
  • 4 Botter A, Oprandi G, Lanfranco F, Allasia S, Maffiuletti NA, Minetto MA. Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning. Eur J Appl Physiol 2011; 111 (10) 2461-2471
    CrossrefPubMedSearch in Google Scholar
  • 5 Min HK, Sung K, Yang JH , et al. Can intraoperative motor-evoked potentials predict all the spinal cord ischemia during moderate hypothermic beating heart descending thoracic or thoraco-abdominal aortic surgery?. J Card Surg 2010; 25 (5) 542-547
    CrossrefPubMedSearch in Google Scholar
  • 6 Messé SR, Bavaria JE, Mullen M , et al. Neurologic outcomes from high risk descending thoracic and thoracoabdominal aortic operations in the era of endovascular repair. Neurocrit Care 2008; 9 (3) 344-351
    CrossrefPubMedSearch in Google Scholar