Abstract • A review of the literature suggests that paraplegia associated with thoracic aortic surgery is preventable if intraoperative hypotension is eliminated, the distal aorta perfused adequately, and the intercostal arteries below T-8 level preserved. A surgical technique has been developed that leaves the posterior aortic wall, preserving the intercostal arteries below the level of T-8, and interspersing a diagonally tailored prosthesis with the aid of left atrial-to-femoral arterial bypass without heparinization. Seven patients with extensive aneurysms involving the entire descending thoracic aorta were operated on successfully by this technique without neurological complications. (Arch Surg 111:1186-1189, 1976) References 1. Lawrence H, Hessel EA, Sauvage LR, et al: Results of the use of the TDMAC heparin shunt in the surgery of aneurysms of the descending aorta. J Thorac Cardiovasc Surg, to be published. 2. Buxton B, Harlan BJ, Cooley DA: Surgical treatment of fusiform thoracic aortic aneurysms by external reinforcement . Bull Texas Heart Inst 3:35-41, 1976. 3. Djindjian R, Hurth M, Houdart M, et al: Arterial supply of the spinal cord , in Angiography of the Spinal Cord . Baltimore, University Park Press, 1970, pp 3-13. 4. Cole PT, Gutelius JR: Neurologic complications of operations on the descending thoracic aorta . Can J Surg 12:435-443, 1969. 5. Adamkiewicz A: Die Blutgefässe des menschlichen Rückenmarkesoberfläche . Sitz Acad Wiss Wien Math Natur Klass 85:101, 1882. 6. Wakabayashi A, Connolly JE, Stemmer EA, et al: Heparinless left heart bypass for resection of thoracic aortic aneurysms . Am J Surg 130:212-218, 1975.Crossref 7. Connolly JE, Wakabayashi A, German JC, et al: Clinical experience with pulsatile left heart bypass without anticoagulation for thoracic aneurysms . J Thorac Cardiovasc Surg 62:568-576, 1971. 8. Lam CR, Aram HH: Resection of descending thoracic aorta for aneurysms: Report of use of homograft in case and experimental study . Ann Surg 134:743, 1951.Crossref 9. Pasternak BM, Boyd DP, Ellis HF: Spinal cord injury after procedures on the aorta . Surg Gynecol Obstet 135:29-34, 1972. 10. Crawford ES, Rubio PA: Reappraisal of adjuncts to avoid ischemia in the treatment of aneurysms of descending thoracic aorta . J Thorac Cardiovasc Surg 66:693-704, 1973. 11. Eiseman B, Summers WB: Factors affecting spinal cord ischemia during aortic occlusion . Surgery 38:1063-1070, 1955. 12. DeBakey ME, Cooley DA, Crawford ES, et al: Aneurysms of the thoracic aorta: Analysis of 179 patients treated by resection . J Thorac Surg 36:393-420, 1958. 13. Ellis FH, Kirklin JW, Bruwer AJ: Surgical experiences in the treatment of aneurysm of the thoracic aorta . Surg Gynecol Obstet 106:179-192, 1958. 14. Hara M, Raymond JL: Spinal cord injury following resection of abdominal aortic aneurysm . Arch Surg 80:419-423, 1960.Crossref 15. Cole PT, Gutelius JR: Paraplegia resulting from use of the subclavian artery as a shunt source during resection of the descending thoracic aorta . Ann Surg 169:293-294, 1969.Crossref 16. Connors JP, Ferguson TB, Roper CL, et al: The use of the TDMAC-Heparin shunt in replacement of the descending thoracic aorta . Ann Surg 181:735-741, 1975.Crossref 17. Reul GJ, Cooley DA, Hallman GL, et al: Dissecting aneurysm of the descending aorta . Arch Surg 110:632-640, 1975.Crossref 18. Killen DA, Edwards RH, Adkins RB, et al: Spinal cord ischemia following mobilization of canine aorta from posterior parietes . Ann Surg 162:1063-1068, 1965.Crossref 19. Fried LC, DiChiro G, Doppman JL: Ligation of major thoraco-lumbar spinal cord arteries in monkeys . J Neurosurg 31:608-614, 1969.Crossref 20. Spencer FC, Zimmerman JM: The influence of ligation of intercostal arteries on paraplegia in dogs . Surg Forum 9:340-342, 1958.
Archives of Surgery – American Medical Association
Published: Nov 1, 1976