MONTRÉAL – A technique developed by a team from the University of Montreal Hospital Center appears to significantly reduce the risk of paraplegia in patients who require surgery for an aortic aneurysm.
The technique has so far been used on only one patient, a 72-year-old man whose aortic aneurysm threatened to rupture at any moment. The risk of paraplegia for this patient would have been nearly 40% with the traditional intervention, a risk that the new technique has lowered to around 5%.
“This now makes it possible to treat a clientele who were considered too high risk for aortic surgery,” explained Doctor Philippe Charbonneau, who is a vascular surgeon at the CHUM and who developed the new technique with his colleague Doctor Jean-François Blair. We can finally offer certain treatments to patients who are at too high a risk of ending up in a wheelchair.”
The SALP technique (for Segmental Artery Laser Preservation) specifically concerns thoraco-abdominal aneurysms, that is to say those which have formed on the part of the aorta which is located astride the thorax and the abdomen.
Until now, to eliminate the threat of aneurysm, vascular surgeons had no choice but to sacrifice several of the small arteries that leave the aorta to supply the spinal cord with blood, hence the risk of paraplegia.
“In open surgery, we are able to (…) make a small bypass in the direction of these open vessels,” explained Dr. Charbonneau. But in endovascular surgery, there is no current technique that allows them to be preserved. These are small arteries of two to four millimeters (and) it is almost impossible to find them endovascularly and to preserve them.
After a traditional intervention, he continues, the patient will eventually naturally develop bypass pathways to perfuse his marrow, “but in some cases, the bypass pathways are not well enough developed.”
“Then this means that these patients can have (…) a spinal infarction, and this leads to paralysis of the legs,” explained Doctor Charbonneau. And that is a disaster, it is the most dramatic situation that a vascular surgeon (…) can encounter in the context of this surgery. Because once the patient is paralyzed, it’s over, he’s in a wheelchair.”
The CHUM team is now using sophisticated imaging techniques to identify these small arteries and protect some of them with a stent during surgery.
Once the procedure is completed, vascular surgeons use a laser to open a “window” that allows these arteries to resume supplying the spinal cord.
“With the technique that we have developed here at the CHUM, we are able to maintain at least one highway, or several natural highways, which make it possible to perfuse and bring blood and oxygen directly to the marrow,” summarized Doctor Charbonneau.
The technique is not suitable for everyone, he specifies, and it is still necessary to find an artery of the right diameter which goes to the marrow, but for patients whose vascular system is in less good condition, “there is an immense advantage in at least preserving one of these highways which allows to pour a large quantity of blood towards the marrow.
“There is great enthusiasm and I have received requests from Europe, the United States, Asia, from surgeons who ask us for advice (…) for their own high-risk patients,” concluded Doctor Charbonneau. It’s quite rewarding and beneficial to be able to help and exchange with these colleagues.”
The findings of this study were published by the European Journal of Vascular and Endovascular Surgery.
