• Moritz S Bischoff, Johannes Scheumann, Robert M Brenner, Dennis Ladage, Carol A Bodian, George Kleinman, Sharif H Ellozy, Gabriele Di Luozzo, Christian D Etz, and Randall B Griepp.
• Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA. moritz.bischoff@mountsinai.org
• Ann. Thorac. Surg. 2011 Jul 1; 92 (1): 138-46; discussion 146.

BackgroundIn a porcine model, we investigated the impact of sudden stent graft occlusion of thoracic intercostal arteries after open lumbar segmental artery (SA) ligation.MethodsAfter randomization into two groups, 20 juvenile Yorkshire pigs (27.1±0.6 kg) underwent open lumbar SA sacrifice (T13-L5) followed by endovascular coverage of all thoracic SAs (T4-T12) at 32°C, either in a single operation (group 1) or in two stages separated by seven days (group 2). Collateral network pressure (CNP) was monitored by catheterization of the SA L1, and postoperative hind limb function was assessed using a modified Tarlov score.ResultsThe CNP in group 1 decreased to 34% of baseline, whereas CNP after lumbar SA ligation in group 2 fell to 55% of baseline (74±2.4 to 25±3.6 mm Hg vs 74±4.5 to 41±5.5 mm Hg; p<0.0001). Subsequent thoracic stenting (group 2) led to another significant but milder drop (p=0.002 versus stage 1) from the restored CNP (71±4.2 to 54±4.9 mm Hg). Five of ten pigs in group 1 suffered paraplegia, in contrast to none in group 2 (median Tarlov score 6, vs 9; p=0.0031). Histopathologic analysis showed more severe ischemic damage to the lower thoracic (p=0.05) and lumbar spinal cord (p=0.002) in group 1.ConclusionsThese results underline the potential of the staged approach in hybrid procedures. Furthermore they highlight the need for established adjuncts for preventing paraplegia in hybrid and pure stent-graft protocols in which sudden occlusion of multiple SAs occurs.Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

34 keywords...

hide…