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• W3080080131 abstract "Central MessageThe large collateral network communicates with the spinal cord network with oxygenation levels correlating by near-infrared spectroscopy from T7 to L5 with the most pronounced ischemia in the lumbar region.See Article page e3. The large collateral network communicates with the spinal cord network with oxygenation levels correlating by near-infrared spectroscopy from T7 to L5 with the most pronounced ischemia in the lumbar region. See Article page e3. The complication rate after thoracoabdominal aortic aneurysm repair has improved over the previous decades, in part because of a decline in spinal cord injury.1Hawkins R.B. Mehaffey J.H. Narahari A.K. Jain A. Ghanta R.K. Kron I.L. et al.Improved outcomes and value in staged hybrid extent II thoracoabdominal aortic aneurysm repair.J Vasc Surg. 2017; 66: 1357-1363Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Adjuncts such as cerebrospinal fluid drainage, hybrid approaches, circulatory support, permissive hypothermia, and segmental artery reimplantation are increasingly used. However, spinal cord ischemia remains a devastating complication, at a rate of 11% in a recent large study.2Coselli J.S. Green S.Y. Price M.D. Zhang Q.Z. Preventza O. de la Cruz K.I. et al.Spinal cord deficit after 1114 extent II open thoracoabdominal aortic aneurysm repairs.J Thorac Cardiov Sur. 2020; 159: 1-13Abstract Full Text Full Text PDF Scopus (41) Google Scholar Efforts continue to further reduce the morbidity and costs associated with paralysis. In this month's issue of the Journal, von Aspern and colleagues3von Aspern K. Haunschild J. Khachatryan Z. Simoniuk U. Ossmann S. Borger M.A. et al.Mapping the collateral network: optimal near-infrared spectroscopy optode placement.J Thorac Cardiovasc Surg. 2022; 164: e3-e15Abstract Full Text Full Text PDF Scopus (6) Google Scholar present an excellent analysis of how to optimize near-infrared spectrometry (NIRS) as an additional tool to detect and avoid ischemia. This study used a porcine model of spinal cord ischemia and reperfusion, via repetitive aortic crossclamping. The NIRS electrodes detected tissue oxygenation levels of the collateral network with no difference at the high thoracic level (T1-T6) and suppression below this level with the most pronounced decreases in the lumbar region. These measurements were then correlated with microsphere perfusion measurements. Although NIRS measurements remained suppressed, microsphere measurements demonstrated increased perfusion toward the end of the ischemic time, a compensatory change worth further investigation. To paraphrase James Carville, it's the anatomy, stupid! Previous work by Etz and colleagues4Etz C.D. Kari F.A. Mueller C.S. Silovitz D. Brenner R.M. Lin H.M. et al.The collateral network concept: a reassessment of the anatomy of spinal cord perfusion.J Thorac Cardiovasc Surg. 2011; 141: 1020-1028Abstract Full Text Full Text PDF PubMed Scopus (225) Google Scholar demonstrated about 75% of segmental arteries give rise to an anterior spinal artery that supplies the intraspinal collateral network. However, segmental arteries also communicate with a large network in the paravertebral tissues and paraspinal muscles (the collateral network; Figure 1). The paraspinal collateral network is vastly larger than the anterior spinal artery/epidural arcade. This collateral network communicates with the intraspinal network, and the authors have shown here that paraspinal placement of NIRS correlates with and detects spinal cord ischemia. However, the internal thoracic arteries (when still present) likely provide too much collateral flow to make high thoracic NIRS routinely useful. The application of mid-thoracic to lumbar NIRS for central nervous system monitoring during thoracoabdominal aortic aneurysm repair is an anatomically and now physiologically supported adjunct in the ever-evolving quest to eliminate spinal cord ischemia. Clinical comparisons with motor-evoked and somatosensory-evoked potentials are warranted. Mapping the collateral network: Optimal near-infrared spectroscopy optode placementThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 1PreviewParaplegia after extensive aortic procedures is a disastrous complication, and maintenance of adequate spinal cord perfusion/oxygenation is pivotal to its prevention. Collateral network (CN) near-infrared spectroscopy (cnNIRS) has been introduced as a noninvasive method for indirect spinal cord oxygenation monitoring. However, the CN has not been investigated in its entirety using this monitoring modality. This study aimed to identify the optimal cnNIRS positioning in an acute large animal model for routine clinical use. Full-Text PDF" @default.
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• W3080080131 title "Commentary: Spinal cord ischemia: It's the anatomy, stupid" @default.
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• W3080080131 doi "https://doi.org/10.1016/j.jtcvs.2020.08.060" @default.
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