VASCULAR MONITORING
Introduction
Vascular surgeries involving blood supply to the brain or spinal cord
may place these structures at risk.
Indications
IONM is useful in carotid endarterectomy where it aids in the decision
whether to shunt around the surgical site during resection. It may also
predict distal embolic events and hypoperfusion. It has also been shown
to be predictive of spinal cord ischemia during aortic aneurysm
resection, where it may also help to identify major arterial feeders to
the spinal cord during their selective temporary occlusion. Several
authors advocate use of monitoring of one type or another including EEG,
evoked potentials and cerebral oxymetry in preventing hypoperfusion
injuries to the brain during cardiac bypass procedures.
Modalities Used
SEP,
EEG, TceMEP, TCD
R. O'Brien MD
References
Halsy, JH. Risks and benefits of shunting in carotid endarterectomy. The
international Transcranial Doppler Collaborators. Stroke 1992;23;1583-87
Quinones-Baldrich WJ, Moore WS.Intraoperative monitoring and use of
the internal shunt during carotid endarterectomy.
Int Surg.
1984 Jul-Sep;69(3):207-13.
Prokop A, Meyer GP, Walter M, Erasmi H. Validity of SEP monitoring in
carotid surgery. Review and own results.
J Cardiovasc Surg
(Torino). 1996 Aug;37(4):337-42.
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