Evolving strategy and results of spinal cord protection in type I and II thoracoabdominal aortic aneurysm repair.

PURPOSE

We report our strategy and results of spinal cord protection in Crawford I and II thoracoabdominal aortic replacement. :

METHODS

Retrospective analysis of 43 elective operations. Before 1994, we reconstructed segmental arteries during a single period of blood flow interruption in 11 of 12 patients, using distal aortic perfusion and evoked spinal cord potential (ESCP) monitoring. Deep hypothermia was used in one. Since 1994, we used multi-segmental sequential repair, in which T8-L1 arteries were sequentially reconstructed irrespective of evoked potential change, in 20 of 31 patients. In the remaining 11, deep hypothermia was used. Cerebrospinal fluid drainage (CSFD) was introduced in 1996 (n=26), and continuous infusion of naloxone in 1999 (n=17).

RESULTS

In patients undergoing distal aortic perfusion without multi-segmental sequential repair, six spinal cord injuries including two deaths occurred. Change in evoked potentials was observed in nine of 10 monitored patients. With multi-segmental sequential repair, only one spinal cord injury occurred, and three of 11 monitored patients showed evoked potential change. With deep hypothermia, no spinal cord injury occurred. Multivariate analysis identified operation without multi-segmental sequential repair as a risk factor for spinal cord injury (p=0.008).

CONCLUSION

Evolving strategy resulted in an improved outcome. Both multi-segmental sequential repair and deep hypothermia were more effective than our previous technique.