Eagleton M J, Greenberg R K
Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine-CWRU, Cleveland, OH 44195, USA.
J Cardiovasc Surg (Torino). 2010 Feb;51(1):71-83.
With the evolution of endovascular therapy, there is a broader application of this technology for the treatment of aortic disease. The span of treatment is no longer limited to the descending thoracic aorta and the infrarenal abdominal aorta. The development of branched aortic endograft therapies has allowed stent graft treatment of more extensive thoracoabdominal aortic aneurysms and more complex aortic pathologies. With this rapidly expanding experience it is possible to better assess the complications that arise with this surgery. Two devastating complications that can occur with conventional aortic surgery are spinal cord and visceral ischemia. The incidence of these complications is low, and is often related to periods of visceral or cord malperfusion during periods of hypotension or aortic cross-clamping. Unfortunately, however, these complications continue to occur despite the use of endovascular technology. As the volume of endovascular aortic procedures increases, it is possible to more accurately assess the incidence of these dreaded complications. In addition, it appears that the pathophysiology associated with their development may occasionally differ from that observed in open surgery. Enhancing our understanding of spinal and visceral ischemia development during aortic endovascular surgery will allow us to more effectively prevent and treat their occurrences. This article will review our current understanding of the incidence, pathophysiology, preventive and treatment options for spinal cord and visceral ischemia associated with endograft surgery of the aorta.
随着血管内治疗的发展，这项技术在主动脉疾病治疗中的应用越来越广泛。治疗范围不再局限于胸降主动脉和肾下腹主动脉。分支型主动脉内移植物治疗的发展使得支架型人工血管能够治疗更广泛的胸腹主动脉瘤和更复杂的主动脉病变。随着这方面经验的迅速积累，我们能够更好地评估该手术所引发的并发症。传统主动脉手术可能出现的两种严重并发症是脊髓缺血和内脏缺血。这些并发症的发生率较低，且通常与低血压或主动脉阻断期间的内脏或脊髓灌注不良有关。然而，不幸的是，尽管采用了血管内技术，这些并发症仍会发生。随着血管内主动脉手术数量的增加，我们能够更准确地评估这些可怕并发症的发生率。此外，似乎与这些并发症发生相关的病理生理学偶尔可能与开放手术中观察到的有所不同。加深我们对主动脉血管内手术期间脊髓和内脏缺血发生情况的理解，将使我们能够更有效地预防和治疗这些并发症。本文将综述我们目前对与主动脉内移植物手术相关的脊髓和内脏缺血的发生率、病理生理学、预防和治疗方法的理解。
