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Althobaiti F, Maghrabi R, Alharbi N, Alwadai M, Almatrafi MK, Bajammal S. Anterior Spinal Artery Syndrome in a Patient With Multilevel Cervical Disc Disease: A Case Report. Cureus 2024; 16:e64577. [PMID: 39011315 PMCID: PMC11249051 DOI: 10.7759/cureus.64577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 07/17/2024] Open
Abstract
Anterior spinal artery syndrome (ASAS) is a rare form of spinal cord infarction, making its incidence and prevalence difficult to determine. We present the case of a 60-year-old woman with multiple vascular risk factors who experienced a sudden onset of severe lower limb weakness, raising immediate concerns about spinal cord ischemia. Diagnostic evaluations confirmed ASAS, although the exact cause and mechanism of her spinal cord infarction remained undetermined. The potential presence of significant cervical disc disease suggests fibrocartilaginous embolism (FCE) as a possible underlying mechanism, despite the lack of direct evidence. This case underscores the importance of clinical awareness and timely intervention in patients with similar symptoms and vascular risk factors. Early recognition, cause identification, and appropriate management are crucial for improving outcomes in spinal cord ischemia, guiding specific treatment strategies, and potentially preventing recurrence.
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Affiliation(s)
| | | | - Naif Alharbi
- Neurology, King Fahad General Hospital, Jeddah, SAU
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Harris ZC, Su HK, Xi AS, Somasundaram A, Sabouri AS. Anterior spinal cord syndrome from a spinal epidural hematoma following removal of an epidural catheter. Can J Anaesth 2024; 71:1037-1042. [PMID: 38750348 DOI: 10.1007/s12630-024-02768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Spinal epidural hematoma (SEH) is a rare yet significant complication associated with neuraxial anesthesia. Here, we present the case of a 74-yr-old male who underwent open repair of an abdominal aortic aneurysm. Following the removal of an epidural catheter, the patient developed anterior spinal cord syndrome due to an SEH despite having a normal coagulation profile. CLINICAL FEATURES This patient's neurologic presentation was marked by a loss of motor function while maintaining fine touch sensation distal to the spinal cord injury. Initial truncal computed tomography (CT) angiography failed to detect vascular compromise or diagnose the SEH. Subsequently, delayed magnetic resonance imaging (MRI) revealed a multilevel thoracic epidural hematoma, spinal cord infarction, and ischemia. Immediate surgical decompression was performed, but unfortunately, the patient had a poor outcome. CONCLUSION Anterior spinal cord syndrome (ASCS) represents an uncommon neurologic manifestation of SEH, which is typically characterized by a triad of back pain and sensory and motor deficits. Although the initial CT scan was necessary to diagnose the postvascular surgery complication, it did not immediately detect the SEH. In cases of ASCS subsequent to thoracic epidural placement and removal, MRI is the preferred imaging modality for precise diagnosis and assessment of the need for surgical intervention. Despite adherence to anticoagulation guidelines, patients undergoing neuraxial anesthesia may face an elevated risk of developing SEH. Health care professionals should remain vigilant in monitoring for neurologic abnormalities following epidural catheter insertion or removal, particularly in the context of vascular surgery.
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Affiliation(s)
- Zechariah C Harris
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Henry K Su
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda S Xi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alwin Somasundaram
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - A Sassan Sabouri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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Yadavalli SD, Wu WW, Rastogi V, Gomez-Mayorga JL, Solomon Y, Jones DW, Scali ST, Verhagen HJM, Schermerhorn ML. Thoracic endovascular aortic repair of metachronous thoracic aortic aneurysms following prior infrarenal abdominal aortic aneurysm repair. J Vasc Surg 2023; 78:614-623. [PMID: 37257669 DOI: 10.1016/j.jvs.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) of metachronous thoracic aortic aneurysms (M-TAAs) following previous infrarenal abdominal aortic aneurysm (AAA) repair has been associated with higher spinal cord ischemia (SCI) risk compared with TEVAR of primary thoracic aortic aneurysms (TAAs). However, data on the impact of the type of prior infrarenal aortic repair on outcomes are scarce. In this study, we examined perioperative outcomes and long-term mortality following TEVAR M-TAA compared with primary TEVAR of TAA. METHODS We identified all Vascular Quality Initiative (VQI) patients who underwent TEVAR of TAA in the descending thoracic aorta from 2013 to 2022. Only patients undergoing primary TEVAR or TEVAR following infrarenal open (OAR) or endovascular (EVAR) repair were included. We performed univariate analyses to identify differences in baseline and procedural characteristics, and multivariable analyses for perioperative outcomes and 5-year mortality using logistic and Cox regression, respectively. RESULTS We included 1493 patients who underwent primary TEVAR (81%) or TEVAR following prior OAR (9.0%) or prior EVAR (9.7%). Compared with primary TEVAR, patients undergoing TEVAR M-TAA were older, more commonly male, white, and had higher rates of hypertension, smoking, and renal dysfunction. Patients with M-TAA were more likely to be asymptomatic and have larger diameters at presentation but were exposed to greater contrast volume and procedural times relative to primary TEVAR patients. Following risk-adjustment, compared with primary TEVAR, TEVAR after prior EVAR was associated with higher perioperative mortality (9.7% vs 3.9%; odds ratio [OR], 5.3; 95% confidence interval [CI], 2.3-12; P < .001) and 5-year mortality (40% vs 24%; hazard ratio [HR], 2.1; 95% CI, 1.4-3.1; P = .001). Specifically, among octogenarians (n = 375; 25%), the perioperative and 5-year mortality differences were even more pronounced (perioperative mortality: 17% vs 8.4%; OR, 6.7; 95% CI, 2.2-21; P = .001; 5-year mortality: 50% vs 27%; HR, 3.0; 95% CI, 1.5-5.7; P = .010). However, in-hospital complications, including SCI (2.6% vs 2.8%; OR, 1.2; 95% CI, 0.33-3.3; P = .77), were not notably different. In contrast, TEVAR after previous OAR was associated with comparable perioperative mortality (4.4% vs 3.9%; OR, 1.2; 95% CI, 0.32-3.8; P = .73), 5-year mortality (28% vs 24%; HR, 1.3; 95% CI, 0.80-2.1; P = .54), and in-hospital complications, including SCI (2.6% vs 0.7%; OR, 0.21; 95% CI, 0.01-1.1; P = .16). CONCLUSIONS Patients undergoing TEVAR of M-TAAs after prior EVAR, particularly octogenarians, have higher perioperative and 5-year mortality and therefore, represent a high-risk group. Future efforts should strive to discern the underlying factors leading to these poorer outcomes; meanwhile, these findings emphasize the need for careful patient selection and appropriate preoperative counseling in these high-risk individuals.
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Affiliation(s)
- Sai Divya Yadavalli
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Winona W Wu
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vinamr Rastogi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jorge L Gomez-Mayorga
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yoel Solomon
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Douglas W Jones
- Department of Surgery, Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA
| | - Salvatore T Scali
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Li J, Peng Y, Zhang X, Yang C, Li X, He H, Li Q, Shu C. Endovascular repair of abdominal aortic or iliac artery pathologies in patients with autosomal dominant polycystic kidney disease. INT ANGIOL 2021; 41:41-47. [PMID: 34751540 DOI: 10.23736/s0392-9590.21.04692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aims to evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) of abdominal aortic or iliac artery pathologies in patients with autosomal dominant polycystic kidney disease (ADPKD). METHODS From January 2014 to December 2019, fifteen consecutive patients (13 men, mean age 69.3 years, range 56-82 years) with abdominal aortic or iliac artery pathologies coexisting with ADPKD underwent EVAR in our department. Their general data, perioperative results and follow-up outcomes were retrospectively reviewed and analyzed. RESULTS:Among the fifteen patients, eleven had abdominal aortic aneurysms, one had isolated abdominal aortic dissection and the other three had iliac artery aneurysms. Three patients had thoracic penetrating aortic ulcer and two had intracranial aneurysms as the comorbidities. All patients underwent EVAR with the aorto-iliac pathologies successfully excluded. The average operative time was 171±73 minutes and average contrast volume was 87±12mL. The average follow-up time was 38.4 months (range 6-60). Aorta-bi-iliac stent-grafts were deployed in fourteen patients, while one patient received tubular stent-graft. Two patients underwent simultaneous TEVAR and EVAR, and One underwent EVAR 3 months after TEVAR. One patient was found to have a hematoma at the site of femoral access 3 days after EVAR. One patient was found to have a Type Ib endoleak 5 months after EVAR, and he recovered well with a secondary endovascular intervention. Contrast-induced nephropathy was observed in two patients (13%) post EVAR. Another patient developed renal failure 20 months after EVAR, and was treated with regular hemodialysis. All other patients did not have any reported significant deterioration of renal function during follow-up. No other adverse events, such as death, paraplegia, aneurysm rupture, or open surgery conversion occurred during operation and follow-up. CONCLUSIONS For patients with abdominal aortic or iliac artery diseases coexisting with ADPKD, EVAR had satisfactory mid-term outcomes, without significantly exacerbating the decline of renal function. However, patients with ADPKD might have multiple vascular lesions, especially intracranial aneurysms, which should be paid enough attention in clinical practice.
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Affiliation(s)
- Jiehua Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Yuan Peng
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Xiaolong Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Chenzi Yang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Xin Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Hao He
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Quanming Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China - .,Vascular Disease Institute, Central South University, Changsha, Hunan, China.,Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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5
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Alektoroff K, Kettner M, Papanagiotou P. [Spinal cord ischemia]. Radiologe 2021; 61:263-266. [PMID: 33580807 DOI: 10.1007/s00117-021-00825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
Spinal cord ischemia is a rare disease with a poor prognosis. As with cerebral ischemia, spinal infarction typically presents with sudden symptom onset and variable clinical manifestation (depending on the lesion location). The majority of spinal ischemias occur in the supply territory of the anterior spinal artery, involving the anterior and middle third of the myelon. The most common cause of spinal ischemia is an arterial vessel occlusion, although venous ischemia and hypotensive watershed infarcts may also occur. Magnetic resonance imaging (MRI) represents the modality of choice for diagnosis of spinal cord ischemia.
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Affiliation(s)
- K Alektoroff
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, 28205, Bremen, Deutschland.
| | - M Kettner
- Klinik für diagnostische und interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - P Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, 28205, Bremen, Deutschland.,Zentrum für Radiologie, Nationale und Kapodistrias-Universität Athen, Aretaieion Uniklinikum, Athen, Griechenland
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Mousa AY, Morcos R, Broce M, Bates MC, AbuRahma AF. New Preoperative Spinal Cord Ischemia Risk Stratification Model for Patients Undergoing Thoracic Endovascular Aortic Repair. Vasc Endovascular Surg 2020; 54:487-496. [PMID: 32495704 DOI: 10.1177/1538574420929135] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Our objective was to determine significant predictors of spinal cord ischemia (SCI) following Thoracic Endovascular Aortic Repair (TEVAR) and to further develop a simple and clinically orientated risk score model. METHODS A retrospective review of data from the Society of Vascular Surgery/Vascular Quality Initiative national data set was performed for all patients undergoing TEVAR from January, 2014 to June 2018. Preoperative demographics, procedure-related variables, and clinical details related to SCI were examined. A SCI risk score was developed utilizing a multivariable logistic regression model. RESULTS For the 7889 patients in the final analysis who underwent TEVAR during the study period, the mean age was 67.6 ± 13.9, range 18 to 90 years, and the majority was male (65%). Postoperative outcomes included stroke (3.0%), myocardial infarction (2.9%), inhospital mortality (5.4%), transient SCI (1.5%), and permanent SCI (2.1%). Nearly half of the overall cases were performed in high volume centers. Predictors of increased risk for SCI included age by decade (odds ratio [OR]: 1.2), celiac coverage (OR: 1.5), current smoker (OR: 1.6), dialysis (OR: 1.9), 3 or more aortic implanted devices (OR: 1.7), emergent or urgent surgery (OR: 1.5), adjunct aorta-related procedure (OR: 2.5), adjunct not related (OR: 2.6), total estimated length of aortic device (19-31 cm, OR: 1.9 and ≥32 cm, OR: 3.0), ASA class 4 or 5 (OR: 1.6), and procedure time ≥154 minutes (OR: 1.8). Two predictors decreased the risk of SCI, cases from high-volume centers (OR: 0.6) and eGFR ≥ 60 (OR: 0.6). To evaluate the risk score model, probabilities of SCI from the original regression, raw score, and raw score categories resulted in area under the curve statistics of 0.792, 0.786, and 0.738, respectively. CONCLUSIONS Spinal cord ischemia remains one of the most feared complications of TEVAR. Incidence of SCI in this large series of patients with TEVAR was 3.6% with nearly 60% being permanent. The proposed model provides an assessment tool to guide clinical decisions, patient consent process, risk-assessment, and procedural strategy.
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Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, WV, USA
| | - Ramez Morcos
- Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA
| | - Mike Broce
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Mark C Bates
- Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, WV, USA
| | - Ali F AbuRahma
- Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, WV, USA
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Surgical Treatment of Synchronous Type B Acute Aortic Dissection and Abdominal Aortic Aneurysm. Ann Vasc Surg 2018; 49:107-114. [PMID: 29481924 DOI: 10.1016/j.avsg.2017.11.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND We report the results of the operative treatment of synchronous type B acute aortic dissection (TBAAD) and infrarenal abdominal aortic aneurysm (AAA). METHODS It is an observational, descriptive multicenter case series. Inclusion criterion was patients with diagnosis of TBAAD and AAA detected synchronously for the first time at clinical onset of dissection. Follow-up imaging protocol included triple-phase spiral/computed tomography angiography performed at 1, 6, and 12 months after thoracic endovascular aortic repair (TEVAR), and annually thereafter. Major end points were perioperative mortality and long-term survival, freedom from aortic events, and freedom from reintervention. RESULTS We identified and treated 15 cases. All TBAADs were treated by TEVAR in the acute phase: infrarenal aortic repair was performed with stent graft (SG) in 10 (66.7%) patients, with open repair in 5 (33.3%). Overall, staged repair was used in 11 (73.3%) patients. Mean descending aortic endovascular length coverage was 21 cm ± 7 (range, 10-35; interquartile range [IQR], 150-265). Overall, early perioperative mortality occurred in 1 (6.7%) patient. Median radiologic follow-up was 48 months (range, 6-120; IQR, 36-67). During the follow-up, TEVAR-related mortality was not observed. Aortic remodeling after TEVAR was obtained in 12 (85.7%) patients; abdominal sac shrinkage after SG was obtained in 8 (80.0%) patients. Freedom from aortic event rate was 79% ± 10 (95% confidence interval [CI]: 53.1-92.6) at 1 year and 64% ± 13 (95% CI: 38.1-83.5) at 5 year. Freedom from reintervention rate at 1 and 5 year was 85% ± 10 (95% CI: 57.8-95.7). CONCLUSIONS In our experience, the association of TBAAD and AAA was a rare finding. Because of the lack of available evidence to opt for a single intervention or a staged approach, selective approach with TEVAR and endovascular/open conventional treatment of the abdominal aorta yielded satisfactory results at midterm follow-up.
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Hsu HC, Fang PH, Lu CH, Shih HI, Lin CH. Acute weakness and numbness of lower limbs. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907917742880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hsiang-Chin Hsu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pin-Hui Fang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-I Shih
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Æsøy MS, Solvang SEH, Grønning M, Rekand T. Epidemiology of persistent iatrogenic spinal cord injuries in Western Norway. Brain Behav 2016; 6:e00522. [PMID: 27781137 PMCID: PMC5064335 DOI: 10.1002/brb3.522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/29/2016] [Accepted: 05/27/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Iatrogenic spinal cord injuries (SCIs) caused by invasive procedures or surgical interventions have previously been reported as case studies. The primary objective of this study was to investigate and analyze the incidence, etiology, and prognosis of iatrogenic SCI in Western Norway. METHODS Medical records of all 183 patients admitted to the SCU between 01.01.2004 and 31.12.2013 were reviewed. Gender, age, diagnosis, iatrogenic medical procedure, symptoms and findings before and after injury, mechanism of injury, level of injury, and ASIA Impairment Scale (AIS) score prior iatrogenic SCI, at admittance and discharge were recorded, as were the length of the period prior to admittance and the length of stay. RESULTS Twenty-three (12.5%; 14 men, nine women) of 183 patients met the criteria for iatrogenic SCI. The annual incidence rate was estimated 2,3 per 1,000,000 (SD ±1.0). Mean age at iatrogenic SCI was 55.5 years (range 16-79 years). Intervention for cervical spinal stenosis was the leading cause of iatrogenic SCI, followed by operations on the aorta and spine. Iatrogenic SCIs was most frequently located on the thoracic level. The patients suffered from clinical incomplete injuries (AIS score C and D) both at admittance and discharge from the SCU. Most patients improved, but no patient recovered completely after SCI. CONCLUSION Although the annual incidence rate of iatrogenic SCI is low in Norway, individual consequences are serious. Increased awareness of the causes of SCI may decrease the risk of iatrogenic SCI.
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Affiliation(s)
- Mathias S Æsøy
- Department of Clinical Medicine University of Bergen Bergen Norway
| | | | - Marit Grønning
- Department of Clinical Medicine University of Bergen Bergen Norway; Department of Occupational Medicine Haukeland University Hospital Bergen Norway
| | - Tiina Rekand
- Department of Neurology Haukeland University Hospital Bergen Norway; Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Zeng Q, Guo X, Huang L, Sun L. Single-center experience with simultaneous thoracic endovascular aortic repair and abdominal endovascular aneurysm repair. Vascular 2016; 25:157-162. [PMID: 27334106 DOI: 10.1177/1708538116651020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective To evaluate the efficacy and outcomes of simultaneous thoracic endovascular aortic repair (TEVAR) and abdominal endovascular aneurysm repair (EVAR). Methods A total of 21 patients (20 men; mean 65 ± 7 years, range 54-77) underwent simultaneous TEVAR and EVAR between September 2010 and June 2015 at a single center were retrospectively reviewed. All patients had concomitant thoracic pathologies (aneurysm, penetrating aortic ulcer, intramural hematoma, or dissection) and abdominal aortic aneurysm. The abdominal aneurysms diameters ranged from 5.9 cm to 10 cm. Thoracic lesions in 17 patients were complicated with acute aortic syndrome, and the remainders had indications for simultaneous repair. All patients were followed up postoperative at 1 month, 6 months, and yearly thereafter. Technique success, procedure-related complications were evaluated. Results All patients received local anesthesia, perioperative relative high arterial pressure (above 130/80 mmHg) maintenance, and prophylactic high-dose corticosteroid. The technical success rate was 100%. Average procedural time was 157.6 ± 45.6 min. The length of thoracic coverage was 20.4 ± 4.7 cm (range 15-27). Two patients required left subclavian artery coverage during TEVAR and two patients required lowest renal artery coverage during EVAR. Chimney stents were deployed simultaneously. Patients were followed between 2 and 59 months postoperatively. No patients developed acute cardiopulmonary complications and contrast-induced nephropathy. Two patients developed transient lower extremity weakness that resolved with blood pressure elevation, cerebrospinal fluid drainage, and intravenous drips of high-dose corticosteroid. The average hospital stay was 10.7 ± 7.9 days (range 4-30). During follow-up, one patient died of aneurysm rupture at postoperative 6 months, two patients developed type Ib endoleak at 9 months and 48 months respectively, one was successfully sealed with iliac stent-graft extension, the other received conservative treatment and is symptom free till now. Conclusion Combined TEVAR and EVAR can be performed safely with minimal morbidity and mortality. When anatomically feasible, simultaneous TEVAR and EVAR can be considered as an acceptable alternative for multilevel aortic diseases.
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Affiliation(s)
- Qinglong Zeng
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vascular Diseases, Beijing, China
| | - Xi Guo
- 2 Interventional Department, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vascular Diseases, Beijing, China
| | - Lianjun Huang
- 2 Interventional Department, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vascular Diseases, Beijing, China
| | - Lizhong Sun
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vascular Diseases, Beijing, China
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Trimarchi S, Kamman A, Lomazzi C, Segreti S, Cova M, De Vincentiis C, Frigiola A, Menicanti L, Marrocco-Trischitta MM, Grassi V, Morganti S, Conti M, Auricchio F, Rampoldi V. Activities at Thoracic Aortic Research Center, IRCCS Policlinico San Donato. Eur Heart J Suppl 2016; 18:E57-E63. [PMID: 28533718 DOI: 10.1093/eurheartj/suw015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Thoracic Aortic Research Center (TARC) of the IRCCS Policlinico San Donato (PSD) aims to promote research on thoracic aortic diseases, to disclose the scientific knowledge and clinical experience and to develop new scientific paths within the Hospital and the aortic community, in collaboration with other national and international centres. Thoracic Aortic Research Center collaborates with many centres in both Europe (e.g. University of Utrecht, the Netherlands) and the USA (e.g. University of Michigan). This has led to multiple highly regarded publications in respected cardiovascular journals and has led to several PhD programmes resulting in doctorate degrees. Within Italy, in association with the Bioengineering School of the University of Pavia, TARC has founded the "BETA-lab" (Biomechanics for Endovascular Treatment of the Aorta laboratory), where MDs, Bioengineers, and PhD fellows conduct experimental studies using in vitro/ex vivo models of the physiologic aorta and aortic diseases. Furthermore, a database (iCardiocloud) where the medical imaging of cardiovascular patients from the PSD is structured, for in silico analysis utilizing computational fluid dynamics, and in vitro studies using also 3D printed aortic models. With the role of principal investigator or co-investigator, TARC at PSD has been participating in other several projects, including the International Registry of Acute Aortic Dissection, the International Aortic Arch Surgery Study Group, the European Registry of Endovascular Aortic Repair Complications, the ADSORB and ASSIST trials, and the GREAT registry. International collaborations have included also studies on predictors of aortic growth after dissection with the Yale University and University of Virginia, and on aortic biomarkers with the University of Tokyo.
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Affiliation(s)
- Santi Trimarchi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Arnoud Kamman
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Chiara Lomazzi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Sara Segreti
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Marta Cova
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Carlo De Vincentiis
- Section of Cardiac Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
| | - Alessandro Frigiola
- Section of Cardiac Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
| | - Lorenzo Menicanti
- Section of Cardiac Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
| | - Massimiliano M Marrocco-Trischitta
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Viviana Grassi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Simone Morganti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | | | - Vincenzo Rampoldi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
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12
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Transient Ischemic Attacks of Spinal Cord due to Abdominal Aortic Aneurysm Thrombus. Ann Vasc Surg 2015; 30:307.e7-9. [PMID: 26520423 DOI: 10.1016/j.avsg.2015.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 11/21/2022]
Abstract
Thrombosis due to abdominal aortic aneurysm is a rare condition that causes high mortality. Transient ischemic attack of the spinal cord can occur as a result of trash emboli from thrombus in abdominal aortic aneurysm. This condition generally occurs during operation of abdominal aortic aneurysm; very rarely, it can also be seen in laminated abdominal aortic aneurysm. Here, we present a case of a patient presenting with bilateral lower extremity paralysis resulting from transient ischemic attack of the spinal cord due to infrarenal abdominal aortic aneurysm.
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Vargas MI, Gariani J, Sztajzel R, Barnaure-Nachbar I, Delattre BM, Lovblad KO, Dietemann JL. Spinal cord ischemia: practical imaging tips, pearls, and pitfalls. AJNR Am J Neuroradiol 2014; 36:825-30. [PMID: 25324492 DOI: 10.3174/ajnr.a4118] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ischemia of the spinal cord is a rare entity with a poor prognosis. Brain ischemia is no longer a diagnostic challenge; on the contrary, ischemia of the spinal cord remains difficult, particularly in children. In this article, we illustrate the principal causes in children and adults, clinical presentation, different techniques for the diagnosis by MR imaging (diffusion, spinal MR angiography, and 1.5 versus 3T), pathophysiology, and differential diagnosis. We will discuss current knowledge, perspectives, and pitfalls.
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Affiliation(s)
- M I Vargas
- From the Divisions of Neuroradiology (M.I.V., I.B.-N., K.O.L.)
| | | | - R Sztajzel
- Neurology (R.S.), Geneva University Hospitals, Geneva, Switzerland
| | | | | | - K O Lovblad
- From the Divisions of Neuroradiology (M.I.V., I.B.-N., K.O.L.)
| | - J-L Dietemann
- Division of Radiology (J.-L.D.), Strasbourg University Hospitals, Strasbourg, France
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