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Simon MV, Dong CC, Jacobs MJ, Mess WH. Neuromonitoring during descending aorta procedures. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:407-431. [PMID: 35772899 DOI: 10.1016/b978-0-12-819826-1.00010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Thoraco-abdominal aneurysm (TAA) repair carries a significant risk of spinal cord infarction. The latter results from irreversible changes in the spinal cord arterial network, e.g., sacrifice of the segmental arteries. Intra-operative neurophysiology with somatosensory and especially motor evoked potential (SEP and MEP respectively) monitoring, has emerged as an effective tool to assess the efficiency of the collateral blood flow, detect reversible spinal cord ischemia and guide the peri-operative multidisciplinary management to prevent postoperative paraplegia. The main roles of such monitoring include diagnosis of spinal cord vs peripheral limb ischemia, titration of mean arterial pressure during aortic clamping, the guidance of selective re-implantation of critical segmental arteries, and management of hemodynamics in the immediate postoperative period. In addition, manipulation of the aortic arch and proximal descending aorta, adds the risk of cerebral infarction from both low flow state and/or thromboembolic events. As such, EEG monitoring may be a useful add-on for either assessment of the efficiency of cerebral cooling as a neuroprotective method and/or for detection and treatment of reversible cerebral ischemia. This chapter presents the multimodality approach to open TAA monitoring as a versatile tool for the prevention of devastating postoperative neurologic deficits.
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Affiliation(s)
- Mirela V Simon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
| | - Charles C Dong
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Michael J Jacobs
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
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Herrera Montano I, Presencio Lafuente E, Breñosa Martínez J, Ortega Mansilla A, Torre Díez IDL, Río-Solá MLD. Systematic Review of Telemedicine and eHealth Systems Applied to Vascular Surgery. J Med Syst 2022; 46:104. [PMID: 36471095 PMCID: PMC9734958 DOI: 10.1007/s10916-022-01895-z] [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] [Received: 05/17/2021] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this paper is to review and analyze the current state of telemedicine and ehealth in the field of vascular surgery. METHODS This paper collects the relevant information obtained after reviewing the articles related to telemedicine in vascular surgery, published from 2012 to 2022 contained in scientific databases. In addition, the results obtained are statistically studied based on various factors, such as the year of publication or the search engine. In this way, we obtain a complete vision of the current state of telemedicine in the field of vascular surgery. RESULTS After performing this search and applying selection criteria, 29 articles were obtained for subsequent study and discussion, of which 20 were published in the second half of the decade, representing 70% of the results. In the analysis carried out according to the search criteria used, it can be seen that using the word telemedicine we obtained 69% of the articles while with the criteria mHealth and eHealth we only obtained 22% and 9% of the results, respectively. It can be seen that the filter with the most potential content articles was "vascular surgery AND telemedicine". In the analysis performed according to the search engine, it was observed that the Google Scholar database contains 93% of the articles found in the massive search and the relevant articles contained therein represent 52% of the total. CONCLUSION An upward trend has been observed in recent years, with a clear increase in the number of publications and much lower figures in the first years. One aspect to highlight is that 47.8% of the articles analyzed focus only on postoperative treatment, which may be due to the help provided by telemedicine in detecting surgical site infections by sending images and videos, this being one of the most common postoperative complications. The analyzed works show the importance of telemedicine in vascular surgery and identify possible future lines of research. In the analysis carried out on the origin of the selected relevant papers, an important interest of the US in this topic is demonstrated since more than 50% of the research contains authors from this country, it is also observed that there is no research from Spain, so this research would be an initial step to determine the weaknesses of telemedicine in this field of medicine and a good opportunity to open a research gap in this branch.
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Affiliation(s)
- Isabel Herrera Montano
- grid.5239.d0000 0001 2286 5329Department of Signal Theory and Communications and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, 47011 Valladolid, Spain
| | - Elena Presencio Lafuente
- grid.5239.d0000 0001 2286 5329Department of Signal Theory and Communications and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, 47011 Valladolid, Spain
| | - Jose Breñosa Martínez
- grid.512306.30000 0004 4681 9396Universidad Europea del Atlántico, C / Isabel Torres, 21, 39011 Santander, Spain
| | - Arturo Ortega Mansilla
- grid.512306.30000 0004 4681 9396Universidad Europea del Atlántico, C / Isabel Torres, 21, 39011 Santander, Spain ,grid.441061.60000 0004 1786 8906Universidad Internacional Iberoamericana, Calle 15 Num. 36, between 10 and 12 IMI III, 24560 - Campeche, Mexico City, Mexico
| | - Isabel de la Torre Díez
- grid.5239.d0000 0001 2286 5329Department of Signal Theory and Communications and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, 47011 Valladolid, Spain
| | - María Lourdes Del Río-Solá
- grid.411057.60000 0000 9274 367XVascular Surgery Department, Hospital Clínico Universitario de Valladolid, Ramón y Cajal Ave, nº 3, 47003 Valladolid, Spain
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Omran S, Raude B, Schawe L, Carstens JC, Angermair S, Berger C, Konietschke F, Treskatsch S, Greiner A. Isolated Ruptured Paravisceral Penetrating Aortic Ulcers. Ann Vasc Surg 2021; 81:138-147. [PMID: 34780950 DOI: 10.1016/j.avsg.2021.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The goal of this study is to investigate the clinical presentation, treatment options, and outcomes of the patients with isolated ruptured paravisceral penetrating aortic ulcers (PV-PAU). METHODS All patients presenting with acute aortic syndrome from 2015 to 2020 were screened, of which patients with isolated ruptured PV-PAU were included in this retrospective study. Study endpoints were the assessment of treatment options, technical success, and clinical outcome. Outcome measures included major perioperative complications and mortality. RESULTS Sixteen patients (11 men; median age 68; IQR 60 - 75 years) presented with isolated ruptured PV-PAU were included in this study. The median follow-up was 25 months (range 1 - 51). Ruptured PV-PAUs represented 12.3% of the ruptured aortic aneurysms in all locations. PV-PAUs were found in segment A (n = 8, 50%), segment B (n = 5, 31%), and segment C (n = 3, 19%). PV-PAUs showed a mean protrusion distance of 27±10 mm, a mean neck diameter of 21 ± 7 mm, and maximal aortic diameter of 50 ± 11 mm. Five patients (31%) showed hemodynamic instability on admission and needed intense fluid resuscitation. Of those, 2 patients needed urgent laparotomy with a fast transabdominal supraceliac aortic clamping, one needed an aortic balloon occlusion to obtain rapid aortic control. The open aortic repair was the most frequently performed surgery (11/16, 69%), followed by hybrid procedures (3/16) and parallel graft chimney technique (2/16). Two patients died during the follow-up, calculating for in-hospital and 1-year mortality rates of 6 - 12%, respectively. The postoperative morbidity rate was 31%. Postoperative complications included acute renal failure (31%), pneumonia (25%), and 1case of ischemic colitis (6%). No spinal cord ischemia was reported. CONCLUSIONS Ruptured PV-PAU is a rare and challenging diagnostic and therapeutic entity. Open aortic repair seems to be a reliable option in treating patients with isolated ruptured PV-PAUs. Hybrid procedures and parallel stent-graft techniques can only be used in selected patients.
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Affiliation(s)
- Safwan Omran
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany.
| | - Ben Raude
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany
| | - Larissa Schawe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany
| | - Jan Christoph Carstens
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany
| | - Stefan Angermair
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Christian Berger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Frank Konietschke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Medical Biometrics and Clinical Epidemiology and Berlin Institute of Health (BIH), Berlin, Germany
| | - Sascha Treskatsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Greiner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany
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Lella SK, Waller HD, Pendleton A, Latz CA, Boitano LT, Dua A. A Systematic Review of Spinal Cord Ischemia Prevention and Management After Open and Endovascular Aortic Repair. J Vasc Surg 2021; 75:1091-1106. [PMID: 34740806 DOI: 10.1016/j.jvs.2021.10.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Spinal cord ischemia (SCI) is one of the most devastating complications after descending thoracic aortic (DTA) and thoracoabdominal aortic (TAA) repairs. Patients who develop SCI have a poor prognosis with mortality rates reaching 75% within the first year after surgery. Many factors have been shown to increase the risk of this complication, including extent of TAA repair, length of aortic and collateral network coverage, embolization, and reduced spinal cord perfusion pressure. As a result, a variety of treatment strategies have evolved. We aimed to provide an up-to-date review of SCI rates with associated treatment algorithms from open and endovascular DTA and TAA repairs. METHODS Using PRISMA guidelines, a literature review with the Medical Subject Headings (MeSH) terms "spinal cord ischemia; spinal cord ischemia prevention and mitigation strategies; spinal cord ischemia rates; spinal cord infarction" was performed in the Cochrane and PubMed databases to seek all peer-reviewed studies of DTA and TAA repairs with SCI complications, limited to 2012-2021 and the English language. MeSH subheadings including diagnosis, complications, physiopathology, surgery, mortality, and therapy were used to further restrict the articles. Studies were excluded if they were not in humans, not pertaining to SCI in DTA/TAA operative repairs, and if the study primarily discussed neuromonitoring techniques. Additionally, studies with <40 patients or limited information regarding SCI protection strategies were excluded. Each study was individually reviewed by two researchers to assess for type and extent of aortic pathology, operative technique, SCI protection or mitigation strategies, rates of overall and permanent SCI symptoms, associations with SCI on multivariate analysis, and mortality. RESULTS Of 450 studies returned by the MeSH search strategy, 41 met inclusion criteria and were included in the final analysis. For endovascular DTA repair patients, overall SCI rates ranged from 0-10.6% with permanent SCI symptoms ranging from 0-5.1%. Endovascular and open TAA repairs had rates of overall SCI of 0-35%. Permanent SCI symptom rate was reported by only one open study at 1.1% while endovascular TAA repairs had between 2-20.5%. CONCLUSION This review provides an up-to-date review of current rates of SCI as well as prevention and mitigation strategies for DTA and TAA repairs. We find that a multimodal approach, including a bundled institutional protocol, staging of multiple repairs, preservation of collateral blood flow network, augmented spinal cord perfusion, selective cerebrospinal fluid drainage, and distal aortic perfusion in open TAA repairs, appears to be important in reducing the risk of SCI.
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Affiliation(s)
- Srihari K Lella
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
| | - Harold D Waller
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alaska Pendleton
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Laura T Boitano
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
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Kerkhof FI, van Schaik J, Massaad RA, van Rijswijk CSP, Tannemaat MR. Measuring CMAPs in addition to MEPs can distinguish peripheral ischemia from spinal cord ischemia during endovascular aortic repair. Clin Neurophysiol Pract 2020; 6:16-21. [PMID: 33490738 PMCID: PMC7804348 DOI: 10.1016/j.cnp.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/23/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022] Open
Abstract
MEP amplitude decreases occur frequently during endovascular aortic aneurysm repair. They are usually caused by peripheral ischemia due to femoral artery sheaths. Peripheral and central ischemia can be distinguished by measuring CMAP amplitudes.
Objective Spinal cord injury is a devastating complication after endovascular thoracic and thoracoabdominal aneurysm repair (EVAR). Motor evoked potentials (MEPs) can be monitored to detect spinal cord injury, but may also be affected by peripheral ischemia caused by femoral artery sheaths. We aimed to determine the incidence of peripheral ischemia during EVAR, and whether central and peripheral ischemia can be distinguished using compound muscle action potentials (CMAPs). Methods We retrospectively analyzed all EVAR procedures between March 1st 2015 and January 1st 2020 during which MEPs were monitored. Peripheral ischemia was defined as both a reduction in MEP amplitudes reversed by removing the femoral sheaths and no clinical signs of immediate post-procedural paraparesis. All other MEP decreases were defined as central ischemia. Results A significant MEP decrease occurred in 14/27 (52%) of all procedures. Simultaneous CMAP amplitude reduction was observed in 7/8 (88%) of procedures where peripheral ischemia occurred, and never in procedures with central ischemia. Conclusions MEP reductions due to peripheral ischemia are common during EVAR. A MEP-reduction without a CMAP decrease indicates central ischemia. Significance CMAP measurements can help to distinguish central from peripheral ischemia, potentially reducing the chance of misinterpreting of MEP amplitude declines as centrally mediated, without affecting sensitivity.
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Affiliation(s)
- Fabian I Kerkhof
- Department of Neurology, Leiden University Medical Center, the Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | - Richard A Massaad
- Department of Surgery, Leiden University Medical Center, the Netherlands
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Oostveen CN, Weerwind PW, Bergs PPE, Schmidli J, Bühlmann R, Schefold JC, Eberle B, Consiglio J, Schälte G, Kotelis D, Hollands AWH, Buhre WFFA, Schurink GWH, Jacobs MJ, van Mook WNKA, Mess WH, Sutedja NA. Neurophysiological and paraspinal oximetry monitoring to detect spinal cord ischemia in patients during and after descending aortic repair: An international multicenter explorative study. Contemp Clin Trials Commun 2020; 17:100545. [PMID: 32181411 PMCID: PMC7063092 DOI: 10.1016/j.conctc.2020.100545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background During descending aortic repair, critically decreased blood flow to the myelum can result in ischemic spinal cord injury and transient or permanent paraplegia. Assessment of motor evoked potentials (MEPs) has been shown to be a valuable tool which allows to detect spinal cord ischemia (SCI) intraoperatively within a therapeutic window suitable to prevent progression to paraparesis or paraplegia. MEP monitoring is not feasible during postoperative care in the awakening patient. Therefore, ancillary techniques to monitor integrity of spinal cord function are needed to detect delayed spinal cord ischemia. Objective The purpose of this study is to evaluate whether assessment of long loop reflexes (LLR; F-waves) and paraspinal muscle oximetry using Near-Infrared Spectroscopy (NIRS) are feasible and valid in detecting delayed SCI. Methods We aim to include patients from three tertiary referral centers undergoing aortic repair with MEP monitoring in this study. F-wave measurements and paraspinal NIRS oximetry will be operated intra- and postoperatively. Measurement characteristics and feasibility will be assessed in the first 25 patients. Subsequently, a second cohort of 75 patients will be investigated to determine the sensitivity and specificity of F-waves and NIRS in detecting perioperative SCI. In this context for the MEP group SCI is defined intraoperatively as significant MEP changes and postoperatively as newly developed paraplegia. Conclusions A clinical study design and protocol is proposed to assess if F-waves and/or NIRS-based paraspinal oximetry are feasible and valid in detecting and monitoring for occurrences of delayed SCI.
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Affiliation(s)
- Cheryl N Oostveen
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Patrick W Weerwind
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Paul P E Bergs
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Jürg Schmidli
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Roman Bühlmann
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Joerg C Schefold
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Balthasar Eberle
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Jolanda Consiglio
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Gereon Schälte
- Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Drosos Kotelis
- Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Angelique W H Hollands
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Wolfgang F F A Buhre
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Geert Willem H Schurink
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Michael J Jacobs
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.,Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Walther N K A van Mook
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Werner H Mess
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Nadia A Sutedja
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
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Intraoperatives Monitoring in der konventionellen und endovaskulären Aortenchirurgie – Etablierte Verfahren. GEFÄSSCHIRURGIE 2019. [DOI: 10.1007/s00772-019-0552-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Gombert A, Grommes J, Hilkman D, Kotelis D, Mess WH, Jacobs MJ. Recovery of lost motor evoked potentials in open thoracoabdominal aortic aneurysm repair using intercostal artery bypass. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:54-57. [PMID: 29725663 PMCID: PMC5928281 DOI: 10.1016/j.jvscit.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/07/2017] [Indexed: 11/20/2022]
Abstract
Ischemia of the spinal cord remains a disastrous complication in thoracoabdominal aortic aneurysm (TAAA) surgery. We report a case of open type I TAAA repair during which no motor evoked potentials were detectable for >1 hour after aortic cross-clamping. The creation of three intercostal artery bypasses restored spinal cord perfusion. As the patient showed only moderate clinical signs of spinal cord ischemia afterward, we underline the role of neuromonitoring to guide intercostal artery bypass implantation during TAAA surgery as the combined use of neuromonitoring and intercostal artery bypass implantation may prevent paraplegia in specific TAAA cases.
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Affiliation(s)
- Alexander Gombert
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jochen Grommes
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Danny Hilkman
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Drosos Kotelis
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michael J Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Systematic review of motor evoked potentials monitoring during thoracic and thoracoabdominal aortic aneurysm open repair surgery: a diagnostic meta-analysis. J Anesth 2016; 30:1037-1050. [DOI: 10.1007/s00540-016-2242-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
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Wynn M, Acher C, Marks E, Acher C. The effect of intercostal artery reimplantation on spinal cord injury in thoracoabdominal aortic aneurysm surgery. J Vasc Surg 2016; 64:289-296. [DOI: 10.1016/j.jvs.2015.12.060] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
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Deldar K, Bahaadinbeigy K, Tara SM. Teleconsultation and Clinical Decision Making: a Systematic Review. Acta Inform Med 2016; 24:286-292. [PMID: 27708494 PMCID: PMC5037984 DOI: 10.5455/aim.2016.24.286-292] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/15/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The goal of teleconsultation is to omit geographical and functional distance between two or more geographically separated health care providers. The purpose of present study is to review and analyze physician-physician teleconsultations. METHOD The PubMed electronic database was searched. The primary search was done on January 2015 and was updated on December 2015. A fetch and tag plan was designed by the researchers using an online Zotero library. RESULTS 174 full-text articles of 1702 records met inclusion criteria. Teleconsultation for pediatric patients accounts for 14.36 percent of accepted articles. Surgery and general medicine were the most prevalent medical fields in the adults and pediatrics, respectively. Most teleconsultations were inland experiences (no=135), and the USA, Italy and Australia were the three top countries in this group. Non-specialists health care providers/centers were the dominant group who requested teleconsultation (no=130). Real time, store and forward, and hybrid technologies were used in 50, 31, and 16.7 percent of articles, respectively. The teleconsultation were reported to result in change in treatment plan, referral or evacuation rate, change in diagnosis, educational effects, and rapid decision making. Use of structured or semi-structured template had been noticed only in a very few articles. CONCLUSION The present study focused on the recent ten years of published articles on physician-physician teleconsultations. Our findings showed that although there are positive impacts of teleconsultation as improving patient management, still have gaps that need to be repaired.
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Affiliation(s)
- Kolsoum Deldar
- Student Research Committee, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Seyed Mahmood Tara
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Fok M, Jafarzadeh F, Sancho E, Abello D, Rimmer L, Howard C, Kennedy T, Hammoud I, Bashir M. Is There Any Benefit of Neuromonitoring during Descending and Thoracoabdominal Aortic Aneurysm Repair? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Matthew Fok
- School of Built Environment, Liverpool John Moores University, Liverpool, UK
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Fatemeh Jafarzadeh
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Elena Sancho
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - David Abello
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Lara Rimmer
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Callum Howard
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Tom Kennedy
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ibrahim Hammoud
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mohamad Bashir
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
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Is There Any Benefit of Neuromonitoring during Descending and Thoracoabdominal Aortic Aneurysm Repair? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:342-8. [DOI: 10.1097/imi.0000000000000187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Paraplegia remains the most feared and a devastating complication after descending and thoracoabdominal aneurysm operative repair (DTA and TAAAR). Neuromonitoring, particularly use of motor-evoked potentials (MEPs), for this surgery has gained popularity. However, ambiguity remains regarding its use and benefit. We systematically reviewed the literature to assess the benefit and applicability of neuromonitoring in DTA and TAAAR. Methods Electronic searches were performed on 4 major databases from inception until February 2014 to identify relevant studies. Eligibility decisions, method quality, data extraction, and analysis were performed according to predefined clinical criteria and end points. Results Among the studies matching our inclusion criteria, 1297 patients had MEP monitoring during DTA and TAAAR. In-hospital mortality was low (6.9% ± 3.6). Immediate neurological deficit was low (3.5% ± 2.6). In one third of patients (30.4% ± 14.2), the MEPs dropped below threshold, which were 30.4% and 29.4% with threshold levels of 75% and 50%, respectively. A range of surgical techniques were applied after reduction in MEPs. Most patients whose MEPs dropped and remained below threshold had immediate permanent neurological deficit (92.0% ± 23.6). Somatosensory-evoked potentials were reported in one third of papers with little association between loss of somatosensory-evoked potentials and permanent neurological deficit (16.7% ± 28.9%). Conclusions We demonstrate that MEPs are useful at predicting paraplegia in patients who lose their MEPs and do not regain them intraoperatively. To date, there is no consensus regarding the applicability and use of MEPs. Current evidence does not mandate or support MEP use.
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Etz CD, Weigang E, Hartert M, Lonn L, Mestres CA, Di Bartolomeo R, Bachet JE, Carrel TP, Grabenwöger M, Schepens MA, Czerny M. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery†. Eur J Cardiothorac Surg 2015; 47:943-57. [DOI: 10.1093/ejcts/ezv142] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wynn MM, Sebranek J, Marks E, Engelbert T, Acher CW. Complications of Spinal Fluid Drainage in Thoracic and Thoracoabdominal Aortic Aneurysm Surgery in 724 Patients Treated From 1987 to 2013. J Cardiothorac Vasc Anesth 2015; 29:342-50. [DOI: 10.1053/j.jvca.2014.06.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Indexed: 11/11/2022]
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Panthee N, Ono M. Spinal cord injury following thoracic and thoracoabdominal aortic repairs. Asian Cardiovasc Thorac Ann 2015; 23:235-246. [DOI: 10.1177/0218492314548901] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objective To discuss the currently available approaches to prevent spinal cord injury during thoracic and thoracoabdominal aortic repairs. Methods We carried out a PubMed search up to 2013 using the Medical Subject Headings: “aortic aneurysm/surgery” and “spinal cord ischemia”; “aortic aneurysm, thoracic/surgery” and “spinal cord ischemia”; “aneurysm/surgery” and “spinal cord ischemia/cerebrospinal fluid”; “aortic aneurysm/surgery” and “paraplegia”. All 190 original articles satisfying our inclusion criteria were analyzed for incidence, predictors, and other pertinent variables related to spinal cord injury, and we compared the results in recent publications with those in earlier reports. Results The mean age of the 38,491 patients was 65.3 ± 4.9 years. The overall incidence of paraplegia and/or paraparesis was 7.1% ± 6.1% (range 0%–32%). The incidence of spinal cord injury before 2000, from 2001 to 2007, and 2008–2013 was 9.0% ± 6.7%, 7.0% ± 6.1%, and 5.9% ± 5.2%, respectively ( p = 0.019). Various predictors of spinal cord injury were identified, extent of disease being the most common. Modification of surgical techniques, use of adjuncts, and better understanding of spinal cord perfusion physiology were attributed to the decrease in postoperative spinal cord injury in recent years. Conclusions Spinal cord injury after thoracic and thoracoabdominal aortic repair poses a real challenge to cardiovascular surgeons. However, with evolving surgical strategies, identification of predictors, and use of various adjuncts over the years, the incidence of spinal cord injury after thoracic/thoracoabdominal aortic repair has declined. Embracing a multimodality approach offers a good insight into combating this grave complication.
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Affiliation(s)
- Nirmal Panthee
- Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan
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Wynn MM, Acher C. A Modern Theory of Spinal Cord Ischemia/Injury in Thoracoabdominal Aortic Surgery and Its Implications for Prevention of Paralysis. J Cardiothorac Vasc Anesth 2014; 28:1088-99. [DOI: 10.1053/j.jvca.2013.12.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Indexed: 11/11/2022]
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Kim SM, Kim SH, Seo DW, Lee KW. Intraoperative neurophysiologic monitoring: basic principles and recent update. J Korean Med Sci 2013; 28:1261-9. [PMID: 24015028 PMCID: PMC3763097 DOI: 10.3346/jkms.2013.28.9.1261] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 07/18/2013] [Indexed: 11/23/2022] Open
Abstract
The recent developments of new devices and advances in anesthesiology have greatly improved the utility and accuracy of intraoperative neurophysiological monitoring (IOM). Herein, we review the basic principles of the electrophysiological methods employed under IOM in the operating room. These include motor evoked potentials, somatosensory evoked potentials, electroencephalography, electromyography, brainstem auditory evoked potentials, and visual evoked potentials. Most of these techniques have certain limitations and their utility is still being debated. In this review, we also discuss the optimal stimulation/recording method for each of these modalities during individual surgeries as well as the diverse criteria for alarm signs.
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Affiliation(s)
- Sung-Min Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyun Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Dae-Won Seo
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Woo Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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Ilić N, Končar I, Dragaš M, Kostic D, Markovic M, Davidovic LB. Intercostal artery reimplantation: a double-edged sword. J Thorac Cardiovasc Surg 2013; 146:726-7. [PMID: 23953302 DOI: 10.1016/j.jtcvs.2013.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/14/2013] [Indexed: 11/29/2022]
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