Directly measuring spinal cord blood flow and spinal cord perfusion pressure via the collateral network: Correlations with changes in systemic blood pressure

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 149; no. 1; pp. 360 - 366
• Main Authors: Kise, Yuya, MD, Kuniyoshi, Yukio, MD, PhD, Inafuku, Hitoshi, MD, PhD, Nagano, Takaaki, MD, Hirayasu, Tsuneo, MD, PhD, Yamashiro, Satoshi, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2015
• Subjects: Animals; Aorta, Abdominal - physiopathology; Aorta, Thoracic - physiopathology; Arterial Pressure; Blood Flow Velocity; Blood Pressure Determination - methods; Cardiothoracic Surgery; Collateral Circulation; Disease Models, Animal; Dogs; Female; Lumbar Vertebrae - blood supply; Regional Blood Flow; Spinal Cord Ischemia - diagnosis; Spinal Cord Ischemia - physiopathology; Time Factors; mPAP; mean proximal arterial pressure; spinal cord blood flow; spinal cord injury; SAP; 26; segmental arterial pressure; 38; CSFP; mSBP; cerebrospinal fluid pressure; SA; ASA; SCBF; Adamkiewicz artery; mDAP; mean distal arterial pressure; mean systemic blood pressure; SCPP; AKA; SCI; spinal cord perfusion pressure; segmental artery; anterior spinal artery
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.09.121

Objective During thoracoabdominal surgery in which segmental arteries are sacrificed over a large area, blood supply routes from collateral networks have received attention as a means of avoiding spinal cord injury. The aim of this study was to investigate spinal cord blood supply through a collateral network by directly measuring spinal cord blood flow and spinal cord perfusion pressure experimentally. Methods In beagle dogs (n = 8), the thoracoabdominal aorta and segmental arteries L1-L7 were exposed, and a temporary bypass was created for distal perfusion. Next, a laser blood flow meter was placed on the spinal dura mater in the L5 region to measure the spinal cord blood flow. The following were measured simultaneously when the direct blood supply from segmental arteries L2-L7 to the spinal cord was stopped: mean systemic blood pressure, spinal cord perfusion pressure (blood pressure within the aortic clamp site), and spinal cord blood flow supplied via the collateral network. These variables were then investigated for evidence of correlations. Results Positive correlations were observed between mean systemic blood pressure and spinal cord blood flow during interruption of segmental artery flow both with ( r  = 0.844, P  < .01) and without ( r  = 0.834, P  < .01) distal aortic perfusion. In addition, we observed significant correlations between spinal cord perfusion pressure and spinal cord blood flow with and without distal perfusion ( r  = 0.803, P  < .001 and r  = 0.832, P  < .01, respectively), and between mean systemic blood pressure and spinal cord perfusion pressure with and without distal perfusion ( r  = 0.898, P  < .001 and r  = 0.837, P  < .001, respectively). The spinal cord was perfused from the collateral network from outside the interrupted segmental arteries, and high systemic blood pressure (∼1.33-fold higher) was needed to obtain the preclamping spinal cord blood flow, whereas 1.68-fold higher systemic blood pressure was needed when distal perfusion was halted. Conclusions Spinal cord blood flow is positively correlated with mean systemic blood pressure and spinal cord perfusion pressure under spinal cord ischemia caused by clamping a wide range of segmental arteries. In open and endovascular thoracic and thoracoabdominal surgery, elevating mean systemic blood pressure is a simple and effective means of increasing spinal cord blood flow, and measuring spinal cord perfusion pressure seems to be useful for monitoring perioperative spinal cord blood flow.