Kari F A, Brenner R M, Müller C S, Griepp R B, Bischoff M S
Abteilung für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Freiburg-Bad Krozingen, Freiburg, Deutschland.
Zentralbl Chir. 2013 Oct;138(5):521-9. doi: 10.1055/s-0032-1328005. Epub 2013 Mar 4.
The spinal cord is particularly susceptible to ischaemic injury following repair of extensive descending thoracic and thoracoabdominal aortic aneurysms (TAAA). For the past decade, the Mount Sinai group in New York has intensively studied the anatomy of the extensive vascular network surrounding the spinal cord, as well as its dynamic morphology in response to decreased blood pressure and flow. Along with clinical data, experimental findings gave rise to the Collateral Network Concept, by which spinal cord injury in open TAAA repair can be significantly reduced. With the more recent widespread use of endovascular repair, strategies to prevent ischaemic spinal cord damage after extensive segmental artery sacrifice/occlusion are still evolving. The hypothesis that dividing extensive aneurysm repair into two steps may mitigate the impact of diminished blood flow to the collateral network has led to a recently conducted series of staged repair experiments. By exploiting the resources of the collateral network, spinal cord injury could be minimised in staged open, as well as in staged hybrid repair and seems equally adoptable for endovascular procedures. The contribution presented herein provides an overview of clinical and experimental studies on the staged approach. Furthermore, it briefly assesses the anatomic rationale for the collateral network concept.
在广泛的降胸段和胸腹主动脉瘤（TAAA）修复术后，脊髓特别容易受到缺血性损伤。在过去十年中，纽约西奈山医疗团队深入研究了脊髓周围广泛血管网络的解剖结构，以及其在血压和血流量降低时的动态形态。结合临床数据，实验结果催生了侧支网络概念，通过这一概念，开放性TAAA修复术中的脊髓损伤可显著减少。随着近期血管内修复术的广泛应用，在广泛节段性动脉牺牲/闭塞后预防缺血性脊髓损伤的策略仍在不断发展。将广泛的动脉瘤修复分为两个步骤可能会减轻侧支网络血流量减少的影响这一假设，引发了最近一系列分期修复实验。通过利用侧支网络的资源，在分期开放性修复以及分期杂交修复中可将脊髓损伤降至最低，并且似乎同样适用于血管内手术。本文所做的贡献概述了分期手术方法的临床和实验研究。此外，还简要评估了侧支网络概念的解剖学原理。
