Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism

Abstract Background Degenerative aortic arch aneurysms are known to develop through a pathological process of arterial atherosclerosis, which could be accompanied by peripheral artery diseases and resultant development of intrapelvic collateral arteries to the ischemic lower limbs. The aim of this s...

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Autores principales:	Kentaro Kiryu, Hiroshi Yamamoto, Takayuki Kadohama, Daichi Takagi, Yoshinori Itagaki, Takuya Wada, Itaru Igarashi
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Frozen elephant trunk Spinal cord ischemia Degenerative arch aneurysm Hypogastric artery Peripheral artery disease Surgery RD1-811 Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/a56d6eaa4e9a4da2bbc08ed3211823c5
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spelling	oai:doaj.org-article:a56d6eaa4e9a4da2bbc08ed3211823c52021-11-28T12:25:21ZRisk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism10.1186/s43057-021-00060-52662-2203https://doaj.org/article/a56d6eaa4e9a4da2bbc08ed3211823c52021-11-01T00:00:00Zhttps://doi.org/10.1186/s43057-021-00060-5https://doaj.org/toc/2662-2203Abstract Background Degenerative aortic arch aneurysms are known to develop through a pathological process of arterial atherosclerosis, which could be accompanied by peripheral artery diseases and resultant development of intrapelvic collateral arteries to the ischemic lower limbs. The aim of this study was to investigate the relationship between peripheral collateral circulation and postoperative paraplegia after total arch repair with a frozen elephant trunk in patients with degenerative aortic arch aneurysms and peripheral artery diseases. Methods Between October 2014 and March 2020, 27 patients (20 men; 69.8 ± 7.7 years old) underwent total arch repair with a frozen elephant trunk. Two of the 27 patients developed paraplegia postoperatively. The patients were divided into two groups, spinal cord ischemia (SCI) group (2 patients) and no-SCI group (25 patients). The aortic shagginess score, arterial calcification (subclavian artery; hypogastric artery) score, and the number of hypogastric artery branches, assessed using preoperative contrast-enhanced computed tomography images, were compared between the two groups. Results The ankle brachial artery pressure index (i.e., lower side value each patient) was lower in the SCI group than that in the no-SCI group (0.64, 0.71, and 1.09±0.07, respectively). There was no difference between the two groups in the arterial calcification scores or the aortic shagginess score. The number of hypogastric artery branches was greater in the SCI group than in the no-SCI group (66, 66, and 30.7±7.5, respectively). Conclusions Enhanced collateral circulation to the ischemic lower limbs in patients with combination of degenerative aortic arch aneurysms and peripheral artery diseases may be involved in paraplegia the upper thoracic spinal cord injury after total arch repair with a frozen elephant trunk.Kentaro KiryuHiroshi YamamotoTakayuki KadohamaDaichi TakagiYoshinori ItagakiTakuya WadaItaru IgarashiSpringerOpenarticleFrozen elephant trunkSpinal cord ischemiaDegenerative arch aneurysmHypogastric arteryPeripheral artery diseaseSurgeryRD1-811Diseases of the circulatory (Cardiovascular) systemRC666-701ENThe Cardiothoracic Surgeon, Vol 29, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Frozen elephant trunk Spinal cord ischemia Degenerative arch aneurysm Hypogastric artery Peripheral artery disease Surgery RD1-811 Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Frozen elephant trunk Spinal cord ischemia Degenerative arch aneurysm Hypogastric artery Peripheral artery disease Surgery RD1-811 Diseases of the circulatory (Cardiovascular) system RC666-701 Kentaro Kiryu Hiroshi Yamamoto Takayuki Kadohama Daichi Takagi Yoshinori Itagaki Takuya Wada Itaru Igarashi Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism
description	Abstract Background Degenerative aortic arch aneurysms are known to develop through a pathological process of arterial atherosclerosis, which could be accompanied by peripheral artery diseases and resultant development of intrapelvic collateral arteries to the ischemic lower limbs. The aim of this study was to investigate the relationship between peripheral collateral circulation and postoperative paraplegia after total arch repair with a frozen elephant trunk in patients with degenerative aortic arch aneurysms and peripheral artery diseases. Methods Between October 2014 and March 2020, 27 patients (20 men; 69.8 ± 7.7 years old) underwent total arch repair with a frozen elephant trunk. Two of the 27 patients developed paraplegia postoperatively. The patients were divided into two groups, spinal cord ischemia (SCI) group (2 patients) and no-SCI group (25 patients). The aortic shagginess score, arterial calcification (subclavian artery; hypogastric artery) score, and the number of hypogastric artery branches, assessed using preoperative contrast-enhanced computed tomography images, were compared between the two groups. Results The ankle brachial artery pressure index (i.e., lower side value each patient) was lower in the SCI group than that in the no-SCI group (0.64, 0.71, and 1.09±0.07, respectively). There was no difference between the two groups in the arterial calcification scores or the aortic shagginess score. The number of hypogastric artery branches was greater in the SCI group than in the no-SCI group (66, 66, and 30.7±7.5, respectively). Conclusions Enhanced collateral circulation to the ischemic lower limbs in patients with combination of degenerative aortic arch aneurysms and peripheral artery diseases may be involved in paraplegia the upper thoracic spinal cord injury after total arch repair with a frozen elephant trunk.
format	article
author	Kentaro Kiryu Hiroshi Yamamoto Takayuki Kadohama Daichi Takagi Yoshinori Itagaki Takuya Wada Itaru Igarashi
author_facet	Kentaro Kiryu Hiroshi Yamamoto Takayuki Kadohama Daichi Takagi Yoshinori Itagaki Takuya Wada Itaru Igarashi
author_sort	Kentaro Kiryu
title	Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism
title_short	Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism
title_full	Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism
title_fullStr	Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism
title_full_unstemmed	Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism
title_sort	risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/a56d6eaa4e9a4da2bbc08ed3211823c5
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Risk factors for spinal cord ischemia in frozen elephant trunk–induced upper spinal cord ischemia in patients with combination of degenerative arch aneurysms and peripheral artery diseases: a possible mechanism

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