Ohira Suguru, Lansman Steven L, Spielvogel David
Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Ann Cardiothorac Surg. 2023 Sep 28;12(5):450-462. doi: 10.21037/acs-2023-scp-15. Epub 2023 Jul 20.
Extensive thoracoabdominal aortic aneurysm repair can cause spinal cord ischemia which significantly impacts survival and quality of life. Although this complication is uncommon, it is important to recognize the pathophysiology and preventative measures. In the 1990s, Dr. Griepp and colleagues proposed the existence of an extensive collateral network that supports spinal cord perfusion, "the collateral network concept". This includes an interconnecting complex of vessels in the intraspinal, paraspinous, and epidural spaces, and in the paravertebral muscles, involving the intercostal and lumbar segmental arteries as well as the subclavian and hypogastric (iliac) arteries. In this concept, as opposed to the one major segmental input model such as the Adamkiewicz artery, recognition of the importance of multiple inputs to the spinal circulation is paramount to maintaining the spinal blood flow and preventing spinal cord ischemia. In this article, we review the current evidence of the collateral concept and its application in aortic surgery.
广泛的胸腹主动脉瘤修复术可导致脊髓缺血，这对生存率和生活质量有显著影响。尽管这种并发症并不常见，但认识其病理生理学和预防措施很重要。在20世纪90年代，格里普博士及其同事提出存在一个支持脊髓灌注的广泛侧支网络，即“侧支网络概念”。这包括脊髓内、椎旁和硬膜外间隙以及椎旁肌肉中的血管相互连接复合体，涉及肋间动脉和腰段动脉以及锁骨下动脉和腹下（髂）动脉。在这个概念中，与单一主要节段性供血模式（如Adamkiewicz动脉）不同，认识到脊髓循环多供血的重要性对于维持脊髓血流和预防脊髓缺血至关重要。在本文中，我们综述了侧支概念的当前证据及其在主动脉手术中的应用。
