First-in-man endovascular preconditioning of the paraspinal collateral network by segmental artery coil embolization to prevent ischemic spinal cord injury

TY - JOUR

T1 - First-in-man endovascular preconditioning of the paraspinal collateral network by segmental artery coil embolization to prevent ischemic spinal cord injury

AU - Etz, Christian D

AU - Debus, E Sebastian

AU - Mohr, Friedrich-Wilhelm

AU - Kölbel, Tilo

N1 - Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

PY - 2015/4

Y1 - 2015/4

N2 - OBJECTIVE: Spinal cord injury remains an invincible complication affecting up to 1 of 5 patients after thoracoabdominal aortic aneurysm repair. A staged surgical approach has been suggested to eliminate paraplegia by induction of arteriogenesis within the paraspinal collateral network; however, its clinical implementation was deferred because it required 2 major procedures.METHODS: First-in-man experience with minimally invasive, selective segmental artery endovascular coil embolization before Crawford type II and III thoracoabdominal aortic aneurysm repair for arteriogenic preconditioning of the collateral network is reported. A 45-year-old man received bilateral elective minimally invasive, selective segmental artery endovascular coil embolization of 2 unilateral lumbar segmental arteries 4 weeks before open surgical repair. A 67-year-old woman who was planned for total endovascular treatment received minimally invasive, selective segmental artery endovascular coil embolization at the fourth lumbar level and coil embolization of the inferior mesenteric artery 8 weeks before endovascular repair.RESULTS: Minimally invasive, selective segmental artery endovascular coil embolization was technically successful and did not result in any neurologic impairment. Both patients were discharged after 72 hours of clinical surveillance. Patient 1 returned for definite open single-stage thoracoabdominal aortic aneurysm repair after 4 weeks and left the hospital without any neurologic impairment on day 35 postoperatively. Patient 2 returned for total endovascular repair 8 weeks after she underwent minimally invasive, selective segmental artery endovascular coil embolization; she recovered well and was discharged without spinal cord injury 8 days after extensive single-stage endovascular thoracoabdominal aortic aneurysm repair. Both patients are alive with no neurologic injury at 1-year follow-up.CONCLUSIONS: Minimally invasive, selective segmental artery endovascular coil embolization for arteriogenic preconditioning of the paraspinal arterial collateral network is clinically feasible and may eventually eliminate ischemic spinal cord injury to enable safe open or endovascular repair of extensive thoracoabdominal aortic aneurysms and prevent paraplegia altogether in the near future.

AB - OBJECTIVE: Spinal cord injury remains an invincible complication affecting up to 1 of 5 patients after thoracoabdominal aortic aneurysm repair. A staged surgical approach has been suggested to eliminate paraplegia by induction of arteriogenesis within the paraspinal collateral network; however, its clinical implementation was deferred because it required 2 major procedures.METHODS: First-in-man experience with minimally invasive, selective segmental artery endovascular coil embolization before Crawford type II and III thoracoabdominal aortic aneurysm repair for arteriogenic preconditioning of the collateral network is reported. A 45-year-old man received bilateral elective minimally invasive, selective segmental artery endovascular coil embolization of 2 unilateral lumbar segmental arteries 4 weeks before open surgical repair. A 67-year-old woman who was planned for total endovascular treatment received minimally invasive, selective segmental artery endovascular coil embolization at the fourth lumbar level and coil embolization of the inferior mesenteric artery 8 weeks before endovascular repair.RESULTS: Minimally invasive, selective segmental artery endovascular coil embolization was technically successful and did not result in any neurologic impairment. Both patients were discharged after 72 hours of clinical surveillance. Patient 1 returned for definite open single-stage thoracoabdominal aortic aneurysm repair after 4 weeks and left the hospital without any neurologic impairment on day 35 postoperatively. Patient 2 returned for total endovascular repair 8 weeks after she underwent minimally invasive, selective segmental artery endovascular coil embolization; she recovered well and was discharged without spinal cord injury 8 days after extensive single-stage endovascular thoracoabdominal aortic aneurysm repair. Both patients are alive with no neurologic injury at 1-year follow-up.CONCLUSIONS: Minimally invasive, selective segmental artery endovascular coil embolization for arteriogenic preconditioning of the paraspinal arterial collateral network is clinically feasible and may eventually eliminate ischemic spinal cord injury to enable safe open or endovascular repair of extensive thoracoabdominal aortic aneurysms and prevent paraplegia altogether in the near future.

KW - Aged

KW - Angiography, Digital Subtraction

KW - Aortic Aneurysm, Thoracic/diagnosis

KW - Aortography/methods

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Collateral Circulation

KW - Embolization, Therapeutic

KW - Endovascular Procedures/adverse effects

KW - Female

KW - Humans

KW - Lumbar Vertebrae

KW - Male

KW - Mesenteric Artery, Inferior/physiopathology

KW - Middle Aged

KW - Regional Blood Flow

KW - Spinal Cord/blood supply

KW - Spinal Cord Ischemia/etiology

KW - Time Factors

KW - Tomography, X-Ray Computed

KW - Treatment Outcome

U2 - 10.1016/j.jtcvs.2014.12.025

DO - 10.1016/j.jtcvs.2014.12.025

M3 - SCORING: Journal article

C2 - 25906717

VL - 149

SP - 1074

EP - 1079

JO - J THORAC CARDIOV SUR

JF - J THORAC CARDIOV SUR

SN - 0022-5223

IS - 4

ER -