Brisard Laurent, El Batti Salma, Borghese Ottavia, Maurel Blandine
Department of Anesthesiology and Critical Care, Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France.
Department of Vascular and Endovascular Surgery, Hôpital Européen Georges Pompidou-Hôpitaux de Paris, Université de Paris Cité, F-75015 Paris, France.
J Clin Med. 2023 Dec 5;12(24):7520. doi: 10.3390/jcm12247520.
Despite recent improvements, spinal cord ischemia remains the most feared and dramatic complication following extensive aortic repair. Although endovascular procedures are associated with a lower risk compared with open procedures, this risk is still significant and must be considered. A combined medical and surgical approach may help to optimize the tolerance of the spinal cord to ischemia. The aim of this review is to describe the underlying mechanism involved in spinal cord injury during extensive endovascular aortic repair, to describe the different techniques used to improve spinal cord tolerance to ischemia-including the prophylactic or curative use of spinal drainage-and to propose our algorithm for spinal cord protection and the rational use of spinal drainage.
尽管近期有所改善，但脊髓缺血仍然是广泛主动脉修复术后最令人担忧且严重的并发症。虽然与开放手术相比，血管内手术的风险较低，但该风险仍然很大，必须予以考虑。综合药物和手术方法可能有助于优化脊髓对缺血的耐受性。本综述的目的是描述广泛血管内主动脉修复术中脊髓损伤的潜在机制，描述用于提高脊髓对缺血耐受性的不同技术，包括预防性或治疗性使用脊髓引流，并提出我们的脊髓保护算法以及脊髓引流的合理使用方法。
