Paraplegia resulting from vessel ligation

STUDY DESIGN

This is a retrospective review of clinical records for evidence of paraplegia specifically resulting from segmental vessel ligation during anterior spinal surgery.

OBJECTIVES

To determine the precise risk rate, and to potentially identify risk factors.

SUMMARY OF BACKGROUND DATA

Although many authors have alluded to this risk, the exact risk rate and risk factors have never been identified.

METHODS

All patients having an anterior approach involving T1-L3 were reviewed. The two reviewers were not involved in any of the surgeries. The 1197 cases were consecutive from 1967 to 1991.

RESULTS

There were no paralyses.

CONCLUSIONS

There would appear to be virtually no risk to segmental vessel ligation provided: 1) vessel ligation is unilateral, 2) done on the convexity of a scoliosis, 3) ligated at midvertebral body level, and 4) hypotensive anesthesia is avoided. Soft clamping with somatosensory-evoked potential monitoring does not appear justified.

Retrograde aortic dissection occurring during cardiopulmonary bypass. Successful repair and concominant subclavian-to-coronary artery vein bypass

A retrograde aortic dissection that occurred during cardiopulmonary bypass was successfully repaired. The cause of dissection was related to the jet of retrograde perfusion. The use of subclavian-to-coronary artery vein bypass when the ascending aorta is not suitable for vein anastomosis because of dissection or aneurysms appears to be a satisfactory alternative to aorta-coronary bypass.

Endarterectomy and thrombectomy for the totally occluded extracranial internal carotid artery. Use of Fogarty balloon catheters

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