1130_Stern.pdf

1、Spinal Cord Drains:Is there a need for prophylactic placement?Jordan R.Stern,MDAssociate Professor of SurgeryWeill Cornell MedicineNew York,NYRelevant DisclosuresConsulting Fees Cook MedicalSpinal Cord Ischemia(SCI)Perhaps most devastating complication of both open and endovascular aortic aneurysm r

2、epair Occurs in 8-15%of endo TAAA repair(F/BEVAR)1 Interruption of spinal cord perfusion leading to cord infarction and neurologic deficit Most common presentation is anterior cord syndrome:Paraparesis/paraplegia,loss of temperature and pain sensation Loss of bladder/bowel control Preserved proprioc

3、eption Posterior symptoms can also occur but less common Severity may range from minor weakness to complete paralysis1 Pini et al,JVS 2022SCI:Etiology&Risk Factors Interruption of segmental intercostal/lumbar arteries by stent graft Systemic hypotension and/or significant blood loss in patients with

4、 marginal perfusion Embolic phenomena Most important factors in determining SCI risk:collateral circulation Length of coverage(i.e.#of segmental intercostal/lumbar branches)2 Patency of hypogastric and subclavian arteries3 Prior aortic surgery(both open/endo)22 Bisdas T et al,JVS 20153 Eagleton MJ e

5、t al,JVS 2014Spinal Cord Perfusion Pressure and Drainage Spinal perfusion pressure(SCPP)is difference between MAP and intraspinal/intrathecal pressure(ISP)In cases of marginal perfusion,maximizing SCPP can be done by:Augmenting MAP Decreasing ISP Drain is placed into intrathecal space to drain CSF G

6、oal of drainage is to decrease ISP,thereby maximizing SCPPSpinal Drainage:Benefits and Risks Prophylactic use of spinal cord drains could theoretically prevent watershed infarcts in marginal patients by minimizing ISP before the insult occurs Routine practice for open TAA and TAAA repair,translated