Near-infrared Spectroscopy Monitoring of the Collateral Network Prior to, During, and After Thoracoabdominal Aortic Repair: A Pilot Study

作者：Etz C D^*; von Aspern K; Gudehus S; Luehr M; Girrbach F F; Ender J; Borger M; Mohr F W

来源：European Journal of Vascular and Endovascular Surgery, 2013, 46(6): 651-656.

DOI：10.1016/j.ejvs.2013.08.018

• Collateral network
• NIRS
• Non-invasive monitoring
• Spinal cord ischemia
• Spinal cord protection
• TEVAR
• Thoracoabdominal aortic repair

Objective: The aim of this study was to evaluate the feasibility of non-invasive monitoring of the paraspinous collateral network (CN) oxygenation prior to, during, and after thoracoabdominal aortic repair in a clinical series. %26lt;br%26gt;Methods: Near-infrared spectroscopy optodes were positioned bilaterally over the thoracic and lumbar paraspinous vasculature to transcutaneously monitor muscle oxygenation of the CN in 20 patients (age: 66 10 years; men = 11) between September 2010 and April 2012; 15 had open thoracoabdominal aortic repair (Crawford II and III), three had thoracic endovascular aortic repair (TEVAR; Crawford l), and two had a hybrid repair (Crawford II). CN oxygenation was continuously recorded until 48 hours postoperatively. %26lt;br%26gt;Results: Hospital mortality was 5% (n = 1), 15% suffered ischemic spinal cord injury (SCI). Mean thoracic CN oxygenation saturation was 75.5 8% prior to anesthesia (=baseline) without significant variations throughout the procedure (during non-pulsatile cooling on cardiopulmonary bypass and with aortic cross-clamping; range = 70.6-79.5%). Lumbar CN oxygenation (LbS) dropped significantly after proximal aortic cross-clamping to a minimum after 11.7 +/- 4 minutes (74 +/- 13% of baseline), but fully recovered after restoration of pulsatile flow to 98.5% of baseline. During TEVAR, stent-graft deployment did not significantly affect LbS. Three patients developed relevant SCI (paraplegia n = 1/paraparesis n = 2). In these patients LbS reduction after aortic cross-clamping was significantly lower compared with patients who did not experience SCI (p = .041). %26lt;br%26gt;Conclusions: Non-invasive monitoring of CN oxygenation prior to, during, and after thoracoabdominal aortic repair is feasible. Lumbar CN oxygenation levels directly respond to compromise of aortic blood circulation.

• 出版日期2013-12