Kozlov B N, Panfilov D S, Saushkin V V, Kuznetsov M S, Nasrashvili G G, Andriianova A V, Shipulin V M
Cardiovascular Surgery Department, Scientific Research Institute of Cardiology, Tomsk, Russia.
Angiol Sosud Khir. 2017;23(1):82-86.
Spinal ischaemia in patients after reconstruction of the thoracic aorta is referred to the category of the most severe postoperative complications, especially in hybrid interventions. The present study was aimed at assessing the risks for the development of spinal ischaemia in patients after implantation of the 'E-vita open plus' stent graft into the descending portion of the thoracic aorta during hybrid reconstruction. The 'E-vita open plus' hybrid stent graft (Jotec, Germany) was implanted to 18 patients presenting with various pathology of the thoracic aorta (dissection, aneurysms). All operations were carried out in the conditions of moderate hypothermia, circulatory arrest and antegrade perfusion of the brain through the brachiocephalic trunk. It was determined that the distal end of the stent graft was located at the level of Th7-Th12. In 12 (66.7%) cases the 'lower' edge of the stent graft was located at the level of thoracic vertebrae Th8-Th9. Before the operation the number of open pairs of intercostal arteries amounted to 10 [9, 11]. After the operation, the number of the open pairs of the segmental arteries amounted to 3 [1; 4], they were all in the lower thoracic portion; the above-located intercostal arteries were shut by the stent graft. In 17 (94.5%) cases in the early postoperative period there were no signs of spinal ischaemia. Only one (5.5%) patient was clinically diagnosed to have developed transient spinal ischaemia noted to disappear spontaneously within the first 24 hours. A conclusion was made that using the 'E-vita open plus' stent graft in the course of hybrid reconstruction of the thoracic aorta was accompanied by the minimal risk for spinal ischaemic complications. The level of the location of the distal edge of the stent graft is not the determining factor in the risks of spinal complications in of such similar operations.
胸主动脉重建术后患者发生脊髓缺血属于最严重的术后并发症范畴，尤其是在杂交手术中。本研究旨在评估在杂交重建过程中，将“E-vita open plus”支架型人工血管植入胸主动脉降部后患者发生脊髓缺血的风险。“E-vita open plus”杂交支架型人工血管（德国Jotec公司）被植入18例患有各种胸主动脉病变（夹层、动脉瘤）的患者体内。所有手术均在中度低温、循环停止以及通过头臂干进行脑顺行灌注的条件下进行。确定支架型人工血管的远端位于Th7-Th12水平。在12例（66.7%）病例中，支架型人工血管的“下缘”位于胸椎Th8-Th9水平。术前开放的肋间动脉对数量为10[9,11]。术后，节段性动脉的开放对数量为3[1;4]，均位于胸段下部；位于上方的肋间动脉被支架型人工血管封闭。在17例（94.5%）病例的术后早期未出现脊髓缺血迹象。仅1例（5.5%）患者经临床诊断发生短暂性脊髓缺血，在最初24小时内自行消失。得出的结论是，在胸主动脉杂交重建过程中使用“E-vita open plus”支架型人工血管，脊髓缺血并发症的风险最小。在这类类似手术中，支架型人工血管远端边缘的位置水平并非脊髓并发症风险的决定性因素。
