通过专门的预防方案,在血管内主动脉修复后可持续地避免脊髓缺血
Lina Rosvall1,2, Angelos Karelis1,2, Björn Sonesson1,2
1Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Malmö, Sweden.
Frontiers in cardiovascular medicine
|August 16, 2024
概括
在复杂的内血管大动脉修复 (EVAR) 后预防脊髓缺血 (SCI) 的专用方案表明,持续性SCI的发病率很低. 女性,破裂动脉瘤和功能不全被确定为更高的风险因素.
科学领域:
- 血管外科 血管外科
- 神经外科 神经外科
- 心血管研究研究心血管研究
背景情况:
- 复杂的内血管大动脉修复 (EVAR) 携带脊髓缺血 (SCI) 的风险.
- 为减轻这种风险,实施了一项专门的SCI预防协议.
- 了解SCI复杂后EVAR的发病率和风险因素对于患者的治疗结果至关重要.
研究的目的:
- 分析脊髓缺血 (SCI) 在复杂的内血管大动脉修复 (EVAR) 后的发生率.
- 评估专门的SCI预防方案的有效性.
- 在复杂的EVAR后识别与SCI相关的风险因素.
主要方法:
- 在6年内对205名接受复杂EVAR (BEVAR/FEVAR) 的患者进行了回顾性审查.
- 实施预防方案,包括分阶段修复,保持平均动脉压 (MAP) >80 mmHg,Hb>110 g/L,以及早期的神经监测.
- 选择性使用预防性脑脊髓液排水 (CSFD).
主要成果:
- 整体SCI的发病率很低,持续性SCI在右侧脉动动脉瘤 (JRA) 中为0.6%,胸腹大动脉动脉瘤 (TAAA) 中为4.0%.
- 患有SCI的患者更常见的是女性,呈现出破裂动脉瘤,并且患有手术前功能不全.
- 技术成功率为83.5%,临床成功率为75.4%.
结论:
- 专门的SCI预防方案与复杂的EVAR后持久性SCI的发病率较低有关.
- 女性性别,破裂动脉瘤和手术前功能衰竭是SCI的重要危险因素.
- 需要进一步的研究来为高风险患者群体量身定制预防方案.
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