Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Экспериментальное исследование роли коллатерального кровоснабжения спинного мозга в профилактике спинальных осложнений при операциях на грудном и торакоабдоминальном отделах аорты

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Link: Clinical Physiology of Blood Circulaiton. 2013; (): -

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Abstract

Objective. To determine the role of collateral blood supply of the spinal marrow for preventing spinal complications when operating on the thoracic aortic aneurysm and thoracoabdominal aneurysm of aorta. The trial experiment has been carried out on rabbits.
Material and methods. The trials have been carried out on 12 intact male grey rabbits with the mass of 3.5 to 4 kg. 4 rabbits were included in the first group. The intercostal arteries of the rabbits were clipped simultaneously from the level of Th8 to Th12 and lumbar arteries from the level of L1 to L2 with two separate incisions. 4 rabbits were included in the second group. At the first stage the intercostal arteries of rabbits were clipped from the level of Th8 to Th12. 4 days later during the second stage the lumbar arteries were clipped from the level of L1 to L2 using two separate incisions. 4 rabbits were included in the third group. At the first stage the lumbar arteries of rabbits were clipped from the level of L1 to L2. 4 days later at the second stage the intercostal arteries were clipped from the level of Th8 to Th12 with two separate incisions.
Results. In the first group the complications developed in 3 (75%) rabbits: 2 rabbits appeared to have paraplegia, 1 rabbit had paraparesis. The research of histological tissue has shown reducing the number of α-motorneurons and glial cells in the anterior horns of the spinal marrow. 1 (25%) rabbit didn’t report having any spinal dysfunction. In the second group 1 rabbit (25%) suffered complications in the form of paraplegia. The complications have happened after the first stage (clipping 6 intercostal arteries) which is why the second stage has not been carried out. The research of histological tissue taken from the rabbit with paraplegia has marked decreasing the number of α-motorneurons. Other rabbits had no spinal complications. The third group didn’t report any neurologic complications.
Conclusion. Two-staged surgical treatment considering the collateral blood supply of the spinal marrow allows to reduce the frequency of ischemia damage of the spinal marrow. The succession of staged treatment also influences the frequency of spinal complications.

References

Бокерия Л.А., Аракелян В.С. Хирургия аневризм грудного и торакоабдоминального отделов аорты. М.: НЦССХ им. А.Н. Бакулева РАМН, 2010. 394 с.
Лазорт Г., Гуазе А., Джинджиан Р. Васкуляризация и гемодинамика спинного мозга. М.: Медицина, 1977. 256 с.
Папиташвили В. Г. Роль дооперационной диагностики особенностей кровоснабжения спинного мозга в разработке тактики хирургического лечения у больных с заболеваниями грудного и торакоабдоминального отделов аорты: Дис. … канд. мед. наук. М., 2008. 148 с.
Скоромец А. А., Скоромец А. П., Скоромец Т. А. и др. Спинальная ангионеврология: Руководство для врачей. М., МЕДпресс- информ, 2003. С. 608.
Bicknell C.D., Riga C.V., Wolfe J.H. Prevention of paraplegia during thoracoabdominal aortic aneurysm repair // Eur. J. Vasc. Endovasc. Surg. 2009. Vol. 37. Р. 654-660.
Coselli J.S., Bozinovski J., LeMaire S.A. Open surgical repair of 2286 thoracoabdominal aortic aneurysms // Ann. Thorac. Surg. 2007. Vol. 83. Р. 862-864.
Etz C. D., Kari F. A., Mueller C. S. et al. The collateral network concept: A reassessment of the anatomy of spinal cord perfusion // J. Thorac. Cardiovasc. Surg. 2011. Vol. 141. P. 1020-1028.
Etz C. D., Kari F. A., Mueller C. S. et al. The collateral network concept: Remodeling of the arterial collateral network after experimental segmental artery sacrifice // J. Thorac. Cardiovasc. Surg. 2011. Vol. 141. P. 1029-1036.
Etz C. D., Luehr M., Kari F. A. et al. Paraplegia after extensive thoracic and thoracoabdominal aortic aneurysm repair // J. Thorac. Cardiovasc. Surg. 2008. Vol. 135. P. 324-330.
Etz C.D., Luozzo G. D., Zoli S. et al. Direct spinal cord perfusion pressure monitoring in extensive distal aortic aneurysm repair // Ann. Thorac. Surg. 2009. Vol. 87. Р. 1764-1774.
Etz C. D., Zoli S., Bischoff M.S. et al. Measuring the collateral network pressure to minimize paraplegia risk in thoracoabdominal aneurysm resection // J. Thorac. Cardiovasc. Surg. 2010. Vol. 140. P. 125-130.
Etz C. D., Zoli S., Mueller C. S. Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair // J. Thorac. Cardiovasc. Surg. 2010. Vol. 139. P. 1464-1472.
Tarlov I.M. Acute spinal cord compression paralysis // J. Neurosurg. 1972. Vol. 36. Р. 10-20.
Wong D.R., Parenti J.L., Green S.Y. et al. Open repair of thoracoabdominal aortic aneurysm in the modern surgical era: Сontemporary outcomes in 509 patients // J. Am. Coll. Surg. 2011. Vol. 212. Р. 569-579.
Zoli S., Etz C. D., Roder F. et al. Experimental two-stage simulated repair of extensive thoracoabdominal aneurysms reduces // Ann. Thorac. Surg. 2010. Vol. 90. Р. 722-730

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