Aim: Antegrade Selective Cerebral Perfusion (ASCP) with lower body circulatory arrest (LBCA) used in aortic arch surgery can lead to postoperative ischemic organ dysfunctions if it lasts long enough. We aimed to evaluate methods that can provide early detection of spinal cord ischemia during aortic arch surgery. Methods: Thirty consecutive patients were prospectively enrolled and Near infrared spectrometry (NIRS) data obtained from the 5 th and 10 th thoracic vertebral region, S100β protein, lactate blood levels during various operative phases and postoperative neurological outcomes were evaluated. Results: A total of 30 patients underwent elective hemi arch (73.29%) or total arch (23.31%) replacement and with a mean ASCP period of 25.1 ± 19.0 (limits 10-90) minutes. In-hospital mortality was 6.66% (two patients). Paraparesis developed in one patient (3,33%). Thoracic T5 and T10 NIRS values were lowest during the ASCP period (p<0.001) with a good correlation between them (r=0.853, p<0.001). However, a significant difference between the T5 and T10 levels was observed during the same period (55.40 vs 51.07 respectively, p=0.001). A moderately negative correlation between the lactate levels in descending aorta and NIRS values at the T10 level was found during ASCP (r =-0.514, p = 0.004). Conclusion: Thoracic 5 th and 10 th level NIRS monitoring for spinal cord oxygenation were significantly lower during ASCP period compared to the other periods of aortic arch surgery with T10 values being lower than T5 values during the same period indicating a more significant flow disturbance at this level. Measuring lactate levels with thoracic NIRS monitoring seems promising for future studies with larger volumes and longer ASCP periods.

Objective.As aneurysm related events and rupture is not eliminated, postoperative lifelong surveillance is mandatory after endovascular aneurysm repair(EVAR).For surveillance colored Doppler ultrasound(CDUS) is a standard method of noninvasive evaluation having the advantages of availability, cost-effectiveness and lack of nephrotoxicity and radiation.We evaluated CDUS for primary surveillance tool after elective EVAR by comparing with computerized tomography. Methods.Between 2018-2020, 84 consecutive post-EVAR patients were evaluated.Firstly, CDUS was performed by two Doppler operators from the Radiology and computed tomographic angiography (CTA) was performed.A reporting protocol was organized for endoleak detection and largest aneurysm diameter. Results.Among 84 patients, there were 11 detected endoleaks(13,1%) with CTA and 7 of them was detected with CDUS (r=0,884,p<0.001).There is an insufficiency in detecting low flow by CDUS.Eliminating this frailty, there was a strong correlation of aneurysm sac diameter measurement between CTA and CDUS (r=0,777,p<0,001).The sensitivity and specificity of CDUS was 63,6% and 100% respectively.The accuracy was 95,2%.Positive and negative predictive values were 100% and 94,8%.Bland-Altman analysis and linear regression analysis showed no proportional bias (mean difference of 1.5±2.2mm,p=0.233). Conclusions.CDUS promises accurate results without missing any potential complication requiring intervention as Type I or III endoleak.Lack of detecting type II endoleaks may be negligible as sac enlargement was the key for reintervention in this situation and CDUS has a remarkably high correlation with CTA in sac diameter measurement. CDUS may be a primary surveillance tool for EVAR and CTA will be reserved in case of aneurysm sac enlargement,detection of an endoleak,inadequate CDUS or in case of unexplained abdominal symptomatology