초록접수 현황
| 16F-181 | 구연 발표 |
Is reimplantation of intercostal arteries necessary during repair of thoracoabdominal aortic aneurysm? : 10-year single center experience
Suryeun Chung, Kay-Hyun Park, Jun Sung Kim, Cheong Lim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea
Background : Despite development of various techniques for preventing spinal cord injury (SCI), paraplegia remains a devastating complication after thoracoabdominal aortic aneurysm (TAAA) surgery and the role of intercostal artery (ICA reimplantation on prevention of paraplegia is still debatable. We aimed to investigate clinical outcomes and correlation between intercostal reimplantation and SCI after surgery base on 10-year single center experience.
Methods : A retrospective review was done for 140 patients (mean age 56.7±15.7years) who underwent thoracoabdominal aortic aneurysm repair from June 2006 through June 2016. For comparison of postoperative clinical outcomes, the patients were divided into two groups according to ICA implantation; ICAR(n=90)vsnon-ICAR(n=50). SCI was defined as any transient or permanent paraplegia or paraparesis. A mean of 2.03 pairs of intercostal artery were reimplanted with various techniques. Early patency of reimplanted ICA’s was examined by postoperative CT angiography done before discharge in all patients.
Results : The proportion of Crawford type I and II was slightly higher in the ICAR group (79.3%vs50%, p=0.04). ICA reimplanted as an individual Carrel patch had to be taken down due to tear and bleeding in 4 of 48 patients. Early patency rate of intercostal artery was lower when reimplanted via interposition grafts(Table 1). Overall early mortality was 3.5% and there was no significant difference between groups. (6.5%vs 4.3%, p=0.71) SCI occurred 9 patients (9/140, 6.4%) including 5 cases (5/140, 3.5%) of delayed events who recovered without neurologic sequel before discharge. The rate of permanent paraplegia or paraparesis was not different between groups (2.2% vs 4.0%, p=0.62). In multivariate analysis, ICA reimplantation and extent of repair were not shown to be predictor of paraplegia
Conclusion : Our experience suggests that reimplantation of ICA is not mandatory for prevention of spinal cord injury and better to be determined individually. End-to-end interposition of a prosthetic graft resulted in poor early patency of reimplanted ICA.
Methods : A retrospective review was done for 140 patients (mean age 56.7±15.7years) who underwent thoracoabdominal aortic aneurysm repair from June 2006 through June 2016. For comparison of postoperative clinical outcomes, the patients were divided into two groups according to ICA implantation; ICAR(n=90)vsnon-ICAR(n=50). SCI was defined as any transient or permanent paraplegia or paraparesis. A mean of 2.03 pairs of intercostal artery were reimplanted with various techniques. Early patency of reimplanted ICA’s was examined by postoperative CT angiography done before discharge in all patients.
Results : The proportion of Crawford type I and II was slightly higher in the ICAR group (79.3%vs50%, p=0.04). ICA reimplanted as an individual Carrel patch had to be taken down due to tear and bleeding in 4 of 48 patients. Early patency rate of intercostal artery was lower when reimplanted via interposition grafts(Table 1). Overall early mortality was 3.5% and there was no significant difference between groups. (6.5%vs 4.3%, p=0.71) SCI occurred 9 patients (9/140, 6.4%) including 5 cases (5/140, 3.5%) of delayed events who recovered without neurologic sequel before discharge. The rate of permanent paraplegia or paraparesis was not different between groups (2.2% vs 4.0%, p=0.62). In multivariate analysis, ICA reimplantation and extent of repair were not shown to be predictor of paraplegia
Conclusion : Our experience suggests that reimplantation of ICA is not mandatory for prevention of spinal cord injury and better to be determined individually. End-to-end interposition of a prosthetic graft resulted in poor early patency of reimplanted ICA.
첨부파일 : Table1.pptx
책임저자: Suryeun Chung
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea
발표자: Suryeun Chung, E-mail : suryeun.chung@gmail.com