Centre for Cardiovascular Genetics, University College Hospital, University College London Hospital Multidisciplinary Endovascular Team, London, United Kingdom.
J Vasc Surg. 2012 Apr;55(4):1202-5. doi: 10.1016/j.jvs.2011.10.079. Epub 2012 Feb 2.
Spinal cord ischemia (SCI) is a catastrophic complication of thoracoabdominal aortic aneurysm (TAAA) repair. This article describes our early experience with a technique for maintaining perfusion of segmental vessels (intercostals and lumbars) in the early postoperative period after endovascular repair of a TAAA, with "sac perfusion branches" added to custom-made stent grafts. These are closed 7 to 10 days after the first procedure to complete exclusion of the aneurysm. We have used this technique in 10 patients with type II TAAAs. One developed monoparesis of the right leg during a period of hypotension secondary to a cardiac event and died within 30 days. Two patients developed lower limb weakness after closure of the perfusion branches, both with full recovery. Controlled perfusion of segmental vessels with perfusion branches is feasible and may be a useful adjunct to prevent SCI, providing protection to spinal cord perfusion during the immediate postoperative period when risk of SCI is greatest.
脊髓缺血（SCI）是胸主动脉腹主动脉瘤（TAAA）修复的灾难性并发症。本文描述了我们在 TAAA 血管内修复后早期使用一种维持节段血管（肋间和腰动脉）灌注的技术的早期经验，即在定制的支架移植物上增加了“囊腔灌注分支”。这些分支在第一次手术后的 7 至 10 天内关闭，以完全排除动脉瘤。我们已经在 10 例 II 型 TAAA 患者中使用了这种技术。其中 1 例患者在心脏事件引起的低血压期间发生右侧单瘫，在 30 天内死亡。2 例患者在关闭灌注分支后出现下肢无力，均完全恢复。通过灌注分支控制节段血管的灌注是可行的，可能有助于防止 SCI，在 SCI 风险最大的即刻术后期间提供脊髓灌注保护。
