Prevention of paraplegia in pigs by selective segmental artery perfusion during aortic cross-clamping Sven A. Meylaerts, MDa, Peter de Haan, MD, PhDb,

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Prevention of paraplegia in pigs by selective segmental artery perfusion during aortic cross-clamping Sven A. Meylaerts, MDa, Peter de Haan, MD, PhDb, Cor J. Kalkman, MD, PhDb, Joris Jaspers, MScc, Ivo Vanicky, MDd, Michael J.H.M. Jacobs, MD, PhDa Journal of Vascular Surgery Volume 32, Issue 1, Pages 160-170 (July 2000) DOI: 10.1067/mva.2000.107571 Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Schematic representation of tc-MEP recordings in experimental animal (ventral view). Journal of Vascular Surgery 2000 32, 160-170DOI: (10.1067/mva.2000.107571) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Schematic representation of a double lumen perfusion catheter. Journal of Vascular Surgery 2000 32, 160-170DOI: (10.1067/mva.2000.107571) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Identification of a set of critical segmental arteries with tc-MEPs. Successive clamps are placed on individual segmental arteries every 5 minutes in caudal to cranial direction, starting at L6 artery, until spinal cord ischemia is detected with tc-MEPs. Only first step and last (fifth) step are shown. In this example, tc-MEP amplitude decrease demonstrated that L6-L2 arteries were critical for spinal cord blood supply. L1-L6, Lumbar arteries; L, tc-MEP response from left leg; R, tc-MEP response from right leg. Journal of Vascular Surgery 2000 32, 160-170DOI: (10.1067/mva.2000.107571) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Selective segmental artery perfusion: aortoaortic bypass graft (L1 to bifurcation). After aortotomy and introduction of catheter tips into critical segmental arteries, selective segmental artery perfusion is performed through L2-L6 arteries. L1-L6, Lumbar arteries; BP, bypass pressure; BF, total bypass flow; P, centrifugal pump. For clarity's sake, only five perfusion catheters are shown. Journal of Vascular Surgery 2000 32, 160-170DOI: (10.1067/mva.2000.107571) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 tc-MEP amplitudes during 60 minutes of selective perfusion. 1, Starting of bypass graft pump; 2, placement of proximal and distal clamps, resulting in tc-MEP loss; 3, starting of selective perfusion; 4, stopping of selective perfusion, resulting in tc-MEP loss. Journal of Vascular Surgery 2000 32, 160-170DOI: (10.1067/mva.2000.107571) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Bar graph shows histopathologic results. Lumbar spinal cords are divided into 12 equal segments and scored for ischemic damage in group A and group B animals. 1, 1 to 5 eosinophilic neurons; 2, 5 to 10 eosinophilic neurons; 3, more than 10 eosinophilic neurons; 4, small infarction (1/3 of gray matter); 5, moderate infarction (1/3 to 1/2 of gray matter); 6, large infarction (more than 1/2 of gray area). Journal of Vascular Surgery 2000 32, 160-170DOI: (10.1067/mva.2000.107571) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Light micrographs from localized spinal cord sections in three different animals. A, Section of L4 segment of perfused animal shows normal-appearing neurons and no sign of vacuolization (hematoxylin-eosin, original magnification ×35). B, L6 segment of control animal shows large infarction within entire gray matter area. Area between arrows is severely infarcted anterior horn gray matter. Note vacuolization (V) and loss of delineation between gray and white matter structures (hematoxylin-eosin, original magnification ×25). C, Central canal. C, Section of L5 segment in perfused animal that had normal neurologic function despite localized small infarction in anterior horn gray matter (area within arrows ; hematoxylin-eosin, original magnification ×50). Journal of Vascular Surgery 2000 32, 160-170DOI: (10.1067/mva.2000.107571) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions