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Titolo:
Prevention of paraplegia in pigs by selective segmental artery perfusion during aortic cross-clamping
Autore:
Meylaerts, SA; de Haan, P; Kalkman, CJ; Jaspers, J; Vanicky, I; Jacobs, MJHM;
Indirizzi:
Univ Amsterdam, Acad Med Ctr, Dept Vasc Surg, NL-1105 AZ Amsterdam, Netherlands Univ Amsterdam Amsterdam Netherlands NL-1105 AZ Z Amsterdam, Netherlands Univ Amsterdam, Acad Med Ctr, Dept Anesthesiol, NL-1105 AZ Amsterdam, Netherlands Univ Amsterdam Amsterdam Netherlands NL-1105 AZ Z Amsterdam, Netherlands Univ Amsterdam, Acad Med Ctr, Dept Med Tech Dev, NL-1105 AZ Amsterdam, Netherlands Univ Amsterdam Amsterdam Netherlands NL-1105 AZ Z Amsterdam, Netherlands Slovak Acad Sci, Dept Neurobiol, Bratislava, Slovakia Slovak Acad Sci Bratislava Slovakia ept Neurobiol, Bratislava, Slovakia
Titolo Testata:
JOURNAL OF VASCULAR SURGERY
fascicolo: 1, volume: 32, anno: 2000,
pagine: 160 - 170
SICI:
0741-5214(200007)32:1<160:POPIPB>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
MOTOR-EVOKED-POTENTIALS; ANEURYSM REPAIR; THORACOABDOMINAL AORTA; RENAL-FAILURE; OPERATIONS; BYPASS; IDENTIFICATION; SURGERY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
21
Recensione:
Indirizzi per estratti:
Indirizzo: Jacobs, MJHM Univ Amsterdam, Acad Med Ctr, Dept Vasc Surg, Meibergdreef 9,Suite G4-112,NL-1105 AZ Amsterdam, Netherlands Univ Amsterdam Meibergdreef 9,Suite G4-112 Amsterdam Netherlands NL-1105 AZ
Citazione:
S.A. Meylaerts et al., "Prevention of paraplegia in pigs by selective segmental artery perfusion during aortic cross-clamping", J VASC SURG, 32(1), 2000, pp. 160-170

Abstract

Purpose: During thoracoabdominal aortic aneurysm repair, a prolonged interruption of the spinal cord blood supply can result in irreversible spinal cord damage, The aim of this study was to investigate whether selective segmental artery perfusion during aortic clamping could prevent paraplegia in pigs. Methods: Specially designed segmental artery perfusion catheters, which could be attached to an extracorporeal bypass graft system, were used. In experiment I (n = 10), it was assessed whether selective segmental artery perfusion could reverse electrophysiologic evidence of spinal cord ischemia andmaintain transcranial motor evoked potentials (tc-MEPs) during 60 minutes of aortic cross-clamping. The abdominal aorta, containing critical segmental arteries, was bypassed through use of an aortoaortic bypass graft system. After the disappearance of tc-MEPs, an aortotomy was followed by selectivesegmental artery perfusion. In experiment II (n = 10), the aim was to determine whether selective segmental artery perfusion could prevent paraplegia. In five animals (group A), aortic cross-clamping was followed by selective segmental artery perfusion; five control animals (group B) underwent segmental artery blockade only. Postoperative hind limb function and spinal cord histopathology were evaluated on the third postoperative day. Results: In experiment I, tc-MEPs disappeared within 3.7 +/- 3.7 minutes after crossclamping and returned in all animals in 8.5 +/- 5.3 minutes afterselective perfusion. During the study period, tc-MEP amplitudes recovered to a median of 49% (range, 28%-113%) of baseline values. Total bypass graftflow was 880 +/- 294 mL/min, of which 184 +/- 54 mL/min was directed to the selective perfusion catheters, The flow in individual catheters was 52 +/- 13 mL/min, In experiment II, all perfused animals demonstrated normal hind limb function, whereas four of five control animals were paraplegic on day 3 (P = .04) In the perfused animals, histopathologic examination showed either no spinal cord damage or eosinophilic neurons only, whereas in paraplegic controls there was infarction in large areas of the cord (P < .0001). Conclusion: In pigs, selective segmental artery perfusion can provide sufficient spinal cord blood flow to prevent paraplegia resulting from 60 minutes of aortic clamping, as shown by clinical outcomes and histopathologic examination.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/06/20 alle ore 01:38:07