Amabile Andrea, Lewis Erin, Costa Victor, Tadros Rami O, Han Daniel K, Di Luozzo Gabriele
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
Vascular. 2023 Oct;31(5):874-883. doi: 10.1177/17085381221094411. Epub 2022 May 4.
Despite advancements in surgical and postoperative management, spinal cord injury has been a persistent complication of both open and endovascular repair of thoracoabdominal and descending thoracic aortic aneurysm. Spinal cord injury can be explained with an ischemia-infarction model which results in local edema of the spinal cord, damaging its structure and leading to reversible or irreversible loss of its function. Perfusion of the spinal cord during aortic procedures can be enhanced by several adjuncts which have been described with a broad variety of evidence in their support. These adjuncts include systemic hypothermia, cerebrospinal fluid drainage, extracorporeal circulation and distal aortic perfusion, segmental arteries reimplantation, left subclavian artery revascularization, and staged aortic repair. The Authors here reviewed and discussed the role of such adjuncts in preventing spinal cord injury from occurring, pinpointing current evidence and outlining future perspectives.
尽管在手术及术后管理方面取得了进展，但脊髓损伤一直是胸腹主动脉瘤和降主动脉瘤开放修复及血管内修复的常见并发症。脊髓损伤可用缺血-梗死模型来解释，该模型会导致脊髓局部水肿，破坏其结构并导致其功能可逆或不可逆丧失。在主动脉手术过程中，可通过多种辅助手段增强脊髓灌注，这些辅助手段已有大量证据支持。这些辅助手段包括全身低温、脑脊液引流、体外循环和远端主动脉灌注、节段动脉再植入、左锁骨下动脉血运重建以及分期主动脉修复。本文作者回顾并讨论了这些辅助手段在预防脊髓损伤方面的作用，明确了当前证据并概述了未来展望。
