Value of the Staged Segmental Crossclamp to the Aorta Technique and Reimplantation of Intercostal Arteries for the Prevention of Spinal Complications Associated with Surgery for Descending and Thoraco-Abdominal Aortic Aneurysms

摘要

Spinal complication associated with descending and thoracoabdominal aortic aneurysm surgery is most serious. This report deals with the value of the segmental crossclamp technique and/or reimplantation of intercostal arteries for the prevention of this serious complication. The subjects were 107 patients, 87 with descending thoracic and 21 with thoracoabdominal aortic aneurysm who were operated on from May 1987 to March 1992 at the National Cardiovascular Center in Osaka. The staged segmental crossclamp technique was applied in 24, while the reconstruction of intercostal arteries was undertaken in 25 patients. Thirteen patients received both procedures simultaneously. The surgical and hospital mortality rates were 1.8% and 8.4%, respectively. Spinal complications were encountered in 11 patients (8.3%), paraplegia in 2 (1.8%) and paralysis in 7 (6.5%). The incidence of paraplegia or paralysis did not decrease under the crossclamp technique and/or reimplantation of intercostal arteries, although no spinal complication was observed in the last consecutive 33 cases. It was speculated that although advances in surgical techniques in dealing with these lesions have been obtained, these two procedures did not completely prevent spinal ischemia/complication during surgical intervention.