Preventza Ourania, Wheatley Grayson H, Williams James, Ramaiah Venkatesh, Rodriguez-Lopez Julio, Diethrich Edward B
Department of Cardiovascular and Endovascular Surgery Arizona Heart Institute Phoenix, AZ, USA.
Asian Cardiovasc Thorac Ann. 2009 Dec;17(6):568-72. doi: 10.1177/0218492309349813.
Endografting, like open surgical repair of the thoracic aorta, can be complicated by paraplegia. We reviewed our thoracic endografting experience regarding the incidence and treatment of spinal cord neurologic events. Between February 2000 and July 2008, 346 patients underwent endoluminal grafting of the descending thoracic aorta. Indications for intervention included atherosclerotic aneurysms (45.9%), acute and chronic dissections (31.5%), miscellaneous lesions (13.6%), and penetrating aortic ulcers (8.9%). Ten women and 4 men (4.0%), with a mean age of 71.3 years, developed either paraparesis (1.7%) or paraplegia (2.3%). Nine (64.3%) of these patients had an aneurysm, 4 (28.6%) had acute or chronic type B aortic dissection, and 1 (7.1%) had a penetrating aortic ulcer; 3 (21.4%) of them had previously undergone open abdominal aortic aneurysm repair, and 13 (92.9%) required coverage of more than 20 cm of the aorta. Cerebrospinal fluid drainage was instituted in 7/8 paraplegic patients. Eight (57.1%) of the 14 patients recovered fully, 2 (14.3%) experienced partial recovery, and 4 (28.6%) had significant neurological deficits. Paraplegia following thoracic endografting appears to be associated with female sex, long-segment coverage of the thoracic aorta, and aneurysmal disease.
与胸主动脉开放手术修复一样，腔内修复术也可能并发截瘫。我们回顾了我们在胸主动脉腔内修复术方面脊髓神经事件的发生率及治疗情况。2000年2月至2008年7月期间，346例患者接受了胸降主动脉腔内移植术。干预指征包括动脉粥样硬化性动脉瘤（45.9%）、急慢性夹层（31.5%）、其他病变（13.6%）和穿透性主动脉溃疡（8.9%）。10名女性和4名男性（4.0%），平均年龄71.3岁，出现了轻瘫（1.7%）或截瘫（2.3%）。这些患者中9例（64.3%）患有动脉瘤，4例（28.6%）患有急慢性B型主动脉夹层，1例（7.1%）患有穿透性主动脉溃疡；其中3例（21.4%）此前接受过开放性腹主动脉瘤修复术，13例（92.9%）需要覆盖超过20 cm的主动脉。8例截瘫患者中有7例进行了脑脊液引流。14例患者中有8例（57.1%）完全康复，2例（14.3%）部分恢复，4例（28.6%）有明显神经功能缺损。胸主动脉腔内修复术后的截瘫似乎与女性、胸主动脉长节段覆盖及动脉瘤性疾病有关。
