Neurologic deficit in patients at high risk with thoracoabdominal aortic aneurysms: The role of cerebral spinal fluid drainage and distal aortic perfusion*,**
Section snippets
MATERIAL AND METHODS
We based our prospective study on 45 consecutive patients treated for type I or type II TAAA repair between September 18, 1992, and August 8, 1993. There were 36 male and nine female patients. The median age was 63 years (range 28 to 88 years). Fourteen patients (31%) had type I TAAA, and 31 (69%) had type II TAAA. With regard to cause, aneurysms were due to dissection in 24 patients (53%) (3 acute type III, 13 chronic type I, and 10 chronic type III). In 17 patients (38%), aneurysms were due
RESULTS
All patients survived operative repair of TAAA. The 30-day mortality rate was 2 patients out of a total of 45 (4%). Intraoperative cardiac arrest developed in one patient. He was successfully resuscitated, but awoke with paraplegia. Kidney failure also developed in him. The patient and his family opted for withholding the life support systems and subsequently he died. The second patient had successful type II TAAA repair and was discharged from the hospital. Twenty-eight days later he was
DISCUSSION
Perfusion pressure of the spinal cord equals spinal arterial pressure minus CSF pressure. 19 During aortic clamping, in addition to the hemodynamic effect on the heart, distal aortic pressure decreases dramatically, leading to a decrease in spinal arterial pressure. 20 Tissue pressure as measured by CSF pressure increases, markedly compromising the perfusion pressure of the spinal cord.
We chose the combined methods of CSFD and DAP for our current prospective study based on the hypothesis that,
Acknowledgements
We gratefully acknowledge Amy Wirtz Newland for editorial assistance.
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