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Ischemia of the Spinal Cord in Aortic Surgery

Ilic Nikola 

Minerva Medica 2016 

Pagg. 96

Isbn: 9788877118653


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Minerva Medica 2016


Spinal cord ischemia remains the most impressive and colliding complication following open surgical and endovascular aortic procedures. Paraparesis and paraplegia are devastating, having a major invalidating impact on the patient’s life. For the surgeon and the entire team this dramatic adverse event causes a significant concussion.
The author has compiled all available knowledge, information, research and clinical data on spinal cord ischemia after aortic surgery. Following historical reflections he describes the classical anatomy theory, originally addressed by Adamkiewicz. The differences between acute and delayed paraplegia have extensively been explained, including the different strategies to minimize cord ischemia. The author also describes the techniques to assess spinal cord integrity, preconditioning and the approaches to increase and develop collateral pathways. Finally, he discusses the experience after endovascular treatment of descending and thoraco-abdominal aortic aneurysms as well as measures to reduce the incidence of spinal cord ischemia. This book is a comprehensive overview on spinal cord ischemia following aortic procedures and helps in understanding the complexity of the puzzle. It also motivates to continue basic and clinical research in the battle against this terrible medical complication.
Contents 
Vascularization of the spinal cord
 
Classical anatomical theory 
Concept of collateral network 
Biglioli’s theory 
Pathophysiology of blood flow through the spinal cord 
Physiology of blood flow 
Watershed zone concept 
Pathology of the spinal cord infarct 
Aortic cross clamp 
Blood pressure 
Pressure of the cerebrospinal fluid 
Steal phenomenon 
Presurgical assessment of the spinal cord vascularization
Angiographic assessment of intercostal arteries 
CT angiography 
MR angiography 
Etiology of spinal cord ischemia 
Initial experimental studies 
Acute paraplegia 
Delayed paraplegia 
Protection of the spinal cord 
Techniques for reducing the duration of ischemia of the medulla 
Techniques for the preservation of the spinal flow 
Techniques for increasing the tolerance to ischemia 
Techniques to optimize spinal cord perfusion 
Techniques for early detection of spinal cord ischemia 
Techniques for spinal cord ischemic preconditioning 
Spinal ischemia in application of TEVAR methods 
Risk factors for spinal cord ischemia after the application of TEVAR methods 
Mechanisms of spinal cord ischemia in TEVAR
Coverage of the left subclavian artery 
Prevention of spinal cord ischemia during TEVAR
Spinal cord ischemia in abdominal aortic surgery 
Clinical image of medullary infarction

Anterior spinal artery syndrome 
Posterior spinal artery syndrome 
Postsurgical diagnostics 
Treatment


  • Anno 2016
  • Autore Ilic Nikola
  • codice isbn 9788877118653
  • Edizione NOVITA'
  • Nota Copertina flessibile
  • Pagine 96 con 42 figure in nero e a colori e 5 tabelle In lingua INGLESE

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