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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The treatment of aortic dissections type B Stanford using endovascular stents represents one of the newest advances in the treatment of this diseases, less invasive alternative to classic surgical repair. Aortic stent-grafts initially were used in treatment of abdominal aortic aneurysms, and then to treat aneurysms, dissections and traumatic ruptures of the descending aorta, with good early and mid-term outcomes. Thoracic aortic aneurysms are frequently diagnosed in mid-age or elderly patients who have arterial hypertension, coronary artery disease, chronic obstructive pulmonary disease. Scientific data reveal a two-year mortality rate of > 70% in untreated patients, most deaths occurring due severe haemorrhages secondary aneurysm rupture. Development of endovascular techniques is naturally, due to the inherent complications of surgery in the distal thoracic aorta (paraplegia, renal failure, stroke). Endovascular deployment of stent-grafts in the treatment of Stanford B aortic dissections represents a possible and quite safe procedure. There is a continuous debate in medical literature about the best therapeutic decision in the treatment of extensive aortic dissections. We present a case of an extensive dissection of thoraco-abdominal aorta in a 55 years old hypertensive patient treated with an aortic stent-graft. Angiograms performed at the end of the procedure revealed complete occlusion of thoracic dissection, abdominal dissection remains untouched. One and three months post procedural evaluation showed a good follow up, with partial thrombosis of abdominal dissection without renal failure or ischaemic events.
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PMID:[Type B aortic dissection--endovascular stent-graft repair. Case report]. 2050 94

Thoracic aortic surgery still involves a significant risk of neurological complications including stroke and paraplegia, associated with high morbidity and mortality. Intraoperative monitoring of the brain and the spinal cord ischemia, such as 4-channel cerebral In Vivo Optical Spectroscopy (INVOS) and myogenic transcranial motor evoked potentials (MEP), may enable us to prevent the devastating complications by prompt and proper intraoperative management. This review describes our standard methods for these procedures during thoracic aortic surgery.
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PMID:[Intraoperative monitoring of the brain and spinal cord ischemia during thoracic aortic surgery]. 2071 87

Gram-negative (G(-)) bacterial spinal epidural abscess (SEA) in adults is uncommon. Of the 42 adult patients with bacterial SEA admitted to the Chang Gung Memorial Hospital - Kaohsiung, between 2003 and 2007, 12 with G(-) SEA were included in this study. Of these 12 patients, seven were men and five were women; their ages ranged between 17 years and 81 years (median=72.5 years, mean=62.5 years). The patients were admitted at different stages of symptom onset (four were in the acute stage and four each in the subacute and chronic stages) and at different levels of neurologic deficit severity, ranging from back pain to paraplegia. Of these 12 patients, 11 had a medical and/or neurosurgical condition as the preceding event and four had a concomitant infection at other sites. Back pain (83%, 10/12) was the most common clinical presentation, followed by paraparesis (50%, 6/12), radiating pain (33%, 4/12), and urinary retention (25%, 3/12). The following causative G(-) pathogens were detected: Klebsiella pneumoniae (three patients), Salmonella spp. (three), Escherichia coli (two), Enterobacter spp. (two), Aeromonas hydrophila (one), and Prevotella melaninogenica (one). Both Enterobacter strains were resistant to multiple antibiotics. Of the 12 patients, eight (66.7%) had spontaneous SEA, whereas the remaining four had postneurosurgical SEA. Thoracic, lumbar, and thoracolumbar spine segments were the most commonly affected. After receiving medical and/or surgical treatment, 10 of the 12 patients (83%) survived, and all 10 recovered well. In conclusion, G(-) bacterial SEA accounted for 28.5% (12/42) of adult SEA. The causative G(-) pathogens found in this study were different from those reported in Western countries, and the strains noted in our study had multiple antibiotic resistance. Our findings suggest that the choice of initial empirical antibiotics for SEA should be carefully considered.
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PMID:Clinical characteristics and therapeutic outcome of Gram-negative bacterial spinal epidural abscess in adults. 2118 28

We report a case of sudden onset of paraplegia shortly after thoracic epidural catheterization for postoperative analgesia and discuss the possible causes of this event. A 38-year-old woman was scheduled to receive right lobectomy of liver because of hepatocellular carcinoma. Thoracic epidural catheterization for postoperative analgesia was performed before the induction of anesthesia. After skin disinfection and local anesthetic skin infiltration with lidocaine, epidural catheterization through T(10-11) interspace was performed. Dural puncture without any neurological symptoms was noticed in the attempt and the epidural space was successfully identified through T(9-10) interspace in the second attempt. However, acute motor weakness and sensory impairment were met as the epidural catheter was being threaded into the epidural space. Magnetic resonance imaging (MRI) revealed no abnormal findings and the neurological deficits resolved spontaneously within 2h without any sequela. Finally, it was supposed that the transient neurological deficits were resultant from accidental subarachnoid injection of the local anesthetics used for skin infiltration. Preoperative image studies of the spine revealed a relatively short skin-to-dura distance either from median or paramedian approach, which might be the cause of the inadvertent intrathecal injection of local anesthetic during skin infiltration.
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PMID:Sudden transient paraplegia shortly after preoperative thoracic epidural catheterization--a case report. 2119 91

Thoracic aortic traumatic injury is a highly morbid event. Mortality and paraplegia rates after emergent open repair remain high. Now, however, thoracic aortic endografting for trauma (TAET) is commonly used. It is appealing due to reduction of operative stress for the multiply injured trauma victim. This minimizing of stress and risk is secondary to avoidance of thoracotomy, single-lung ventilation, aortic cross-clamping, and the more complex anesthetic techniques required. Early and midterm results from TAET delineate improved outcomes, yet access and aortic constraints continue to challenge TAET. Questions regarding longer-term durability of endografts in younger patients remain unanswered. Broader application of TAET within endovascular programs is challenged by appropriate imaging, operating suite inventories, and the logistics and personnel required for TAET. Currently developed thoracic endograft devices are not ideal for TAET due to platform size and graft diameter. This is changing, however, as new modifications have been developed and trials are ongoing. In light of these collective factors, the management paradigm for traumatic aortic injury is beginning to favor TAET.
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PMID:Endovascular repair of thoracic aortic injury: current thoughts and technical considerations. 2135 15

Thoracic endovascular aortic repair (TEVAR) has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal and distal landing zones for stent-graft anchoring. Many aortic pathologies affect in the immediate proximity of the left subclavian artery (LSA) limiting the proximal landing zone site without proximal vessel coverage. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA's origin with the endovascular stent graft (ESG). This manoeuvre has the potential for immediate and delayed neurological and vascular symptoms. Some authors, therefore, propose prophylactic revascularisation of the LSA by transposition or bypass, while others suggest prophylactic revascularisation only under certain conditions, and still others see no requirement for prophylactic revascularisation in anticipation of LSA ostium coverage. In this review about LSA revascularisation in TEVAR patients with coverage of the LSA, we searched the electronic databases MEDLINE and EMBASE historically until the end date of May 2010 with the search terms left subclavian artery, covering, endovascular, revascularisation and thoracic aorta. We have gathered the most complete scientific evidence available used to support the various concepts to deal with this issue. After a review of the current available literature, 23 relevant articles were found, where we have identified and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals abnormal supra-aortic vascular anatomy or pathology. We further conclude that elective patients undergoing planned coverage of the LSA during TEVAR should receive prophylactic LSA transposition or LSA-to-left-common-carotid-artery (LCCA) bypass surgery to prevent severe neurological complications, such as paraplegia or brain stem infarction.
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PMID:Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation? 2137 12

Thoracic endovascular aortic repair (TEVAR) has rapidly become a viable and accepted treatment option for atherosclerotic aortic aneurysms as well as a variety of other aortic pathologies including ulcers, dissection, coarctation and disruption. Left subclavian artery (LSA) coverage is often necessary to achieve proximal seal in up to 40% of patients treated with TEVAR. The management of the LSA in this cohort of patients remains controversial. Studies in support of routine pre-operative LSA revascularization show that coverage of the LSA during TEVAR is associated with an increased risk of stroke, paraplegia and arm ischemia. Other studies show that intentional coverage of the LSA without revascularization is not associated with increased morbidity and lends support to those who advocate more selective LSA revascularization during TEVAR (i.e. in those patients with patent LIMA-coronary bypass, dominant or isolated left vertebral artery, or a functioning left upper extremity (LUE) dialysis arteriovenous fistula). This paper is intended to review the literature comparing routine and selective LSA revascularization after TEVAR to determine the best management strategy.
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PMID:Left subclavian artery coverage during TEVAR: is revascularization necessary? 2245 34

The endovascular repair of thoracic aortic aneurysm and abdominal aortic aneurysm has become a promising alternative for open surgical graft replacement. The benefits of EVAR include less invasiveness, no need for cardiopulmonary bypass or differential lung ventilation, less blood loss, shorter hospital stay and reduced perioperative morbidity and mortality. Therefore EVAR is especially desirable for patients with impaired cardiopulmonary function or multiple comorbidities and they are at high risk of complications following general anesthesia such as stroke, myocardial infarction, acute renal insufficiency, infection and failure to wean from ventilator. Thoracic endovascular aortic repair (TEVAR) also carries the risk of paraplegia induced by spinal cord ischemia. Previous abdominal aortic aneurysm repair, prolonged hypotension, severe atherosclerosis of the thoracic aorta, injury to the external iliac artery, and more extensive coverage of the thoracic aorta by the graft are reported to be the risk factors for paraplegia after TEVAR. In such cases, strategies to protect the spinal cord from ischemia including lumbar cerebrospinal fluid drainage should be taken.
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PMID:[Anesthetic considerations for endovascular aortic repair (EVAR)]. 2323 25

Thoracic aorta blunt injury (BAI) is a highly lethal lesion. A large number of victims die before obtaining emergency care. Thoracic endovascular aneurysm repair (TEVAR) is a less invasive method compared with open surgery and may change protocols for BAI treatment. This retrospective study was developed to evaluate the potential issues about thoracic endografting in the management of these patients. Twenty-seven patients with a BAI underwent aortic stent grafting. Intervention was preceded by the treatment of more urgent associated lesions in nine cases. In-hospital mortality was 7.4%. No paraplegia or ischemic complications developed because of the coverage of the left subclavian artery. In one case (3.2%), a type I endoleak was detected, proximal endograft infolding in two cases (7.4%) and endograft distal migration in further two cases were detected during follow-up (6-110 months). Thoracic endovascular aneurysm repair of BAI showed encouraging results in terms of perioperative mortality and morbidity. Concerns still remain about the potential mid- and long-term complications in younger patients.
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PMID:Outcomes in the emergency endovascular repair of blunt thoracic aortic injuries. 2364 57

Surgical treatment of thoracic disc herniation is technically challenging from anterior, lateral or posterior approaches. Because of the deeply located thoracic discs and non-retractable thoracic thecal sac, standard anterior and lateral procedures for discectomy require extensive tissue dissection causing prolonged lengths of stay in hospital. In this video, the authors present a case of calcified disc herniation at the level of T10/11 causing paraplegia and voiding difficulty. The patient was operated on via an endoscope-assisted minimally invasive transforaminal thoracic interbody fusion (EA-TTIF). The herniated disc and calcification were removed through a 26-mm tubular retractor, under microscopes via a unilateral transpedicular approach. The endoscopes were used for direct visualization of the ventral thecal sac and confirmation of complete decompression. After the operation, the patient's neurological function completely recovered. Minimally invasive EA-TTIF is a viable and effective option for the surgical management of thoracic disc herniation. Thoracic interbody fusion can be achieved through a minimally invasive approach from the back. The video can be found here: http://youtu.be/54rRMtvSyCM.
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PMID:Endoscope-assisted minimally invasive transforaminal thoracic interbody fusion. 2382 41


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