aDepartment of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania bDepartment of Anesthesiology, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York, USA cDepartment of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel.
Curr Opin Anaesthesiol. 2014 Feb;27(1):98-105. doi: 10.1097/ACO.0000000000000033.
Spinal cord ischemia after thoracoabdominal aortic interventions is a devastating complication because it significantly worsens the perioperative morbidity and mortality. Long-term outcome is also affected because of medical complications which are directly related to the neural deficits. Paraplegia has significant medical, social, and financial aspects. Limited mobility, the need for assistance in activities of daily living, makes paraplegia an important target for prevention. An understanding of spinal cord blood supply, risk factors for spinal ischemia, and strategies for spinal cord rescue in this setting can help minimize the negative outcome effects of this important complication.
The vascular supply of the spinal cord is via an extensive collateral arterial network with multiple auxiliary arterial supplies. Risk factors for spinal cord ischemia include extensive aortic repair, prior aortic repair, spinal cord malperfusion on clinical presentation, systemic hypotension, acute anemia, prolonged aortic clamping, and vascular steal. Spinal rescue strategies include systemic hypothermia, endovascular aortic repair, permissive systemic hypertension, cerebrospinal fluid drainage, pharmacologic neuroprotection, and intensive neuromonitoring.
The progression of spinal cord ischemia after thoracoabdominal aortic interventions can frequently be arrested before irreversible infarction results. This spinal cord rescue depends on the early detection and immediate multimodal intervention to maximize spinal cord oxygen supply. The devastating outcomes associated with spinal infarction in this setting offset the risks and knowledge gaps currently associated with contemporary interventions.
胸腹主动脉介入治疗后脊髓缺血是一种毁灭性的并发症，因为它显著增加了围手术期的发病率和死亡率。长期预后也受到影响，因为与神经缺陷直接相关的医疗并发症。截瘫有显著的医疗、社会和经济方面的影响。活动能力有限，日常生活活动需要帮助，这使得截瘫成为预防的重要目标。了解脊髓的血液供应、脊髓缺血的危险因素以及在此情况下脊髓抢救的策略，可以帮助最大限度地减少这一重要并发症的不良后果。
脊髓的血管供应是通过广泛的侧支动脉网络和多个辅助动脉供应。脊髓缺血的危险因素包括广泛的主动脉修复、先前的主动脉修复、临床表现时脊髓灌注不良、全身低血压、急性贫血、主动脉夹闭时间延长、血管盗血。脊髓抢救策略包括全身低温、血管内主动脉修复、允许性全身高血压、脑脊液引流、药物神经保护和强化神经监测。
在发生不可逆性梗死之前，胸腹主动脉介入治疗后脊髓缺血的进展通常可以被阻止。这种脊髓抢救取决于早期检测和立即进行多模式干预，以最大限度地提高脊髓氧供应。在这种情况下，与脊髓梗死相关的破坏性后果抵消了与当代干预措施相关的风险和知识差距。
