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PubMed1999

Quantitative measurements of venous reflux by duplex scanning of the incompetent long saphenous vein before and after high ligation at the saphenofemoral junction.

OBJECTIVE: To assess the effect of high ligation of the saphenofemoral junction (SFJ) on the amount of reflux in the long saphenous vein using quantitative duplex scanning. DESIGN: Prospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 23 patients presented with 29 limbs showing signs of isolated insufficiency of the long saphenous vein. INTERVENTION: High ligation of the SFJ. MAIN OUTCOME MEASURES: Duration of reflux (s), peak velocity (m/s), mean velocity (m/s) and mean flow (ml/s) at the SFJ, and in the mid-thigh, the distal thigh and the proximal lower leg before and four weeks after high ligation. RESULTS: All variables except duration of reflux improved significantly at all levels in the 29 limbs studied. One limb showed no improvement in flow at the level of the SFJ, 9 in the mid-thigh, 13 in the distal thigh, and 15 in the proximal lower leg (just below the knee). CONCLUSION: High ligation was effective in reducing reflux at the SFJ, but in about half the limbs the distal reflux in the long saphenous vein remained.

Female↗
PubMed2001

Effects of caecal ligation and colostomy on water intake and excretion in chickens.

1. The effect of caecal ligation and colostomy on water intake and excretion were examined in chickens fed a low-protein diet or a low-protein diet supplemented with urea. 2. When fed a low-protein diet, the water intake and the ratio of water intake to food intake were increased by colostomy (P < 0.05) but not changed further by caecal ligation of colostomised chickens. 3. When fed a low-protein diet supplemented with urea, the amount of water intake and the ratio of water intake to food intake were not changed by either treatment. 4. Total water excretion was much higher in the colostomised plus caeca-ligated chickens than in other 3 groups fed both types of diet (P < 0.05). 5. The amount of faecal water excretion was increased by cecal ligation in colostomised chickens fed either diet (P < 0.01). 6. No effect of any treatment on water balance was observed in chickens fed either diet. 7. It is concluded that the lower intestine plays a useful role in the water economy of chickens fed a low-protein diet or a low-protein diet supplemented with urea.

Animal Feed↗
PubMed2002

Rat renal function four days after bile-duct ligation: effects of indomethacin and vasoactive agents.

The purpose of this study was to assess the effects of the cyclooxygenase inhibitor, indomethacin, and some vasoactive agents on the renal functional parameters during the early liver injury induced by four days bile duct ligation (BDL). Wistar rats with four days-BDL and control-sham operated were used. Renal function was measured in anesthetized rat treated with a single dose of indomethacin (control, 0.3, 1.0, 3.0 mg/kg b.w.; i.v.) one hour before clearance studies. Sulindac effects were also evaluated (5 mg/kg b.w., i.p). Isolated rat kidney preparations from control and BDL donor rats were used to study renal vascular response to noradrenaline, carbachol or sodium nitroprusside. The bile duct ligation promoted a diminished renal cortical plasma flow (RCPF) on the fourth day post surgery accompanied with a diminution in the glomerular filtration rate (GFR), increased filtration fraction and increased fractional excretion of water and sodium. Indomethacin 0.3 mg/kg induced an increase in GFR and RCPF, maintaining the high filtration fraction in BDL rats. The other doses did not alter these parameters as compared with bile duct ligated rats without treatment, but indomethacin 3 mg/kg caused a significant increase in filtration fraction. Indomethacin induced dose-dependent diminution in natriuresis in sham and BDL groups. Sulindac did not modify hemodynamic parameters, but induced antinatriuresis and antidiuresis in both experimental groups. Maximal vascular responses to noradrenaline measured in isolated rat kidneys were statistically diminished in BDL-rats as compared with controls (C, n=7; 35.0+/-2.3 mmHg ml(-1) min; BDL-rats, n=5; 23.8+/-0.7 mmHg ml(-1) min; p<0.02), without changes in EC15. Maximal relaxation induced by sodium nitroprusside in the phenylephrine (PHE)-pre-constricted renal vasculature in control preparations did not differ from that observed in BDL group (C: n=6; 49.5+/-2.3%). Values of EC50 were 1.26+/-0.07 microM (n=6) in control preparations and 0.34+/-0.03 microM (n=4) in kidneys from BDL-rats (p<0.001). Carbachol induced a biphasic relaxation of PHE-pre-constricted renal vasculature. No differences in maximal responses were found. EC50 value of the second phase in BDL group was significantly decreased compared to control preparations (C: n=6, 0.47+/-0.05 microM; BDL: n=6, 0.22+/-0.03 microM p<0.001). The present results show that the altered renal function after a short time post bile duct ligation is determined, at least in part, by increased release of arachidonic derivatives in vascular bed and tubular cells. At this stage of liver injury, the alteration in the renal vascular response to different vasoactive agents is remarkable.

Animals↗
PubMed1973

Permeability of Sertoli cell tight junctions to lanthanum after ligation of ductus deferens and ductuli efferentes.

The permeability of Sertoli cell tight junctions to lanthanum administered during fixation has been compared in rats after ligation of the ductus deferens and after ligation of the ductuli efferentes. In both control and vasoligated testes, lanthanum penetrated only short distances into the Sertoli cell tight junctions before stopping abruptly. The tight junction, consisting of numerous pentalaminar fusions of contiguous Sertoli cell membranes, prevented diffusion of lanthanum into the adluminal compartment of the seminiferous epithelium. In rats with ligated ductuli efferentes, lanthanum completely permeated many Sertoli cell tight junctions and occupied intercellular spaces of the adluminal compartment. In spite of their newly acquired permeability to lanthanum, tight junctions retained characteristic ultrastructural features, including numerous membrane fusions. When lanthanum-filled tight junctions were sectioned en face, membrane fusions appeared as pale lines in lakes of electron-opaque tracer. These linearly extensive fasciae occludentes occasionally ended blindly, suggesting that lanthanum may have traversed the junction by diffusing around such incomplete barriers. The increased permeability of Sertoli cell tight junctions after efferent ductule ligation, which caused rapid testicular weight gain followed by atrophy, indicates that tight junctions are sensitive to enforced retention of testicular secretions inside the seminiferous tubules. The apparent normalcy of Sertoli cell tight junctions after vasoligation, which had no effect on testis weight, supports the view that blockage of testicular secretions distal to the epididymis is relatively innocuous.

Animals↗
PubMed2005

The Boatman's knot: a single knot for renal-vein ligation during laparoscopic nephrectomy: description of technique and evaluation of feasibility and safety.

BACKGROUND AND PURPOSE: The endovascular stapler is the standard of care for renal-vein ligation during nephrectomy, but recently, some reports have addressed the need for lowering the costs in the operating room. The authors describe the first use of "boatman's knot" in renal-vein ligation during laparoscopic nephrectomy and tests of its safety and feasibility. MATERIALS AND METHODS: Sixteen bilateral laparoscopic nephrectomies were performed in female pigs. On the right side, the renal vein was ligated with the boatman's knot, and on the left side, the vein was ligated with conventional intracorporeal technique. The knots were performed by the same surgeon at initial laparoscopic training. The time required to tie the knots was measured. After bilateral nephrectomy, a midline incision was created, and the bursting pressure of the knots was measured with a manometer by saline infusion into the vena cava. RESULTS: The average knot-completion time was 45 seconds (range 30-50 seconds), and the average time needed to carry out the conventional suture was 202.5 seconds (range 186-228 seconds). After renal-vein transection, there was complete hemostasis in all cases. The mean bursting pressure was 179.9 mm Hg (range 126-304 mm Hg). In five cases, the rupture site was in a lumbar vein previously sutured, while in three cases, the rupture happened in the vena cava itself. CONCLUSION: The boatman's knot is feasible, safe, easy to learn, and faster than conventional intracorporeal suturing. This technique may replace the endovascular stapler. However, its clinical applicability remains to be determined.

Animals↗
PubMed1982

Appearance of peculiar epithelial cells in the epididymal duct of the mouse ligated epididymis.

The mouse epididymis was ligated at the junction of the head and body at 20 to 30 days or 90 days of age, and examined by light and electron microscopy 30 days after ligation. In the normal mouse, the lumen of the duct in the corpus epididymidis was distended with abundant spermatozoa and PAS-positive material. In the epididymis ligated at 20 to 30 days, the duct of the corpus was decreased in diameter and contained no spermatozoa and little PAS-positive material in the lumen. Peculiar pale, vacuolated cells appeared scattered or clustered in the epithelium in this region. The cells often formed intercellular cysts. The vacuoles and intercellular cysts had long microvilli on their inner surface. In the epididymis ligated at 90 days, few or no pale cells were seen in the epithelium of the duct. These findings imply that the differentiation of the epithelial cells is dependent on the luminal contents of the epididymal duct.

Animals↗
PubMed1991

Conceptus-mediated integrity of endometrial epithelial cells and maintenance of relaxin synthesis in pregnant rabbits: effects of unilateral oviduct ligation.

A previous study indicated rabbit endometrial relaxin synthesis is stimulated by blastocyst (Lee VH, Fields PA, Biol Reprod 1990; 40:737-745). To evaluate this hypothesis, unilateral oviduct ligations were placed (A) at the oviduct isthmus on Day 1 post-copulation and (B), in a separate group of rabbits, at the infundibulum before copulation. Blastocysts migrate into and implant in the uterine horn contralateral to the ligated oviduct only (conceptus-bearing uterus). The uterine horn ipsilateral to the ligated oviduct will be referred to as the non-conceptus-bearing uterus. Uteri and ovaries were removed on Days 4-28 of pregnancy and were evaluated for relaxin using guinea pig anti-porcine relaxin serum and avidin-biotin light microscopy immunohistochemistry. Results were identical for both models. Blastocysts first attach to the antimesometrial uterine surface by Day 7 post-copulation. Implantation on the mesometrial surface occurs on Days 8-11. Relaxin was observed in antimesometrial endometrial glands of both conceptus and non-conceptus-bearing uteri on Days 4-7 of pregnancy. Beyond Day 7, relaxin was observed in antimesometrial and mesometrial endometrial glandular and luminal epithelial cells at implantation sites of the conceptus-bearing uterus only. Relaxin was not found between implantation sites. Endometrial epithelial cells of the non-conceptus-bearing uterus were regressing by Day 9. These data indicate a conceptus-mediated maintenance of endometrial epithelial cells. Furthermore, the data suggest a paracrine maintenance of epithelial cell integrity and relaxin synthesis since these parameters are preserved only in the conceptus-bearing uterus. Cell-cell communication between conceptus and endometrium appears to be specific since endometrium between implantation sites does not contain relaxin. Uterine tissue from pseudopregnant rabbits (Days 1-16) was evaluated. Relaxin was observed in the antimesometrial glands on Day 7 only. Like the endometrium in the ligation model, endometrial epithelial cells of the pseudopregnant rabbit uterus were regressing by Day 9. These results indicate that pregnancy is not required for, but may enhance, relaxin synthesis. In addition, endometrial epithelial cells regress in the absence of pregnancy. Regression of endometrial epithelial cells on Day 9 suggests that maternal recognition of pregnancy occurs during the preimplantation period (Days 4-8).

Animals↗
PubMed1998

Effective analgesia after bilateral tubal ligation.

UNLABELLED: Postpartum bilateral tubal ligation is a brief surgical procedure with minimal tissue injury, yet postoperative recovery times and analgesia requirements are often disproportionately large. To evaluate the analgesic efficacy of local anesthetic infiltration, 20 parturients scheduled for elective minilaparotomy and bilateral tubal ligation with either spinal or epidural anesthesia participated in this prospective, randomized, controlled, double-blind trial. All patients received IV metoclopramide 10 mg and ketorolac 60 mg intraoperatively, as well as preincisional infiltration of the infraumbilical skin incision with 0.5% bupivacaine. Infiltration of bilateral uterine tubes and mesosalpinx was performed with either 0.5% bupivacaine (n = 10) or isotonic sodium chloride solution (saline) (n = 10). IV meperidine (25 mg every 3 min as needed) was given to treat pain in the postanesthesia care unit (PACU). The total amount of meperidine administered in the PACU was significantly larger in the saline group than in the bupivacaine group. Pain scores at 30, 45, 60, 75, and 90 min postoperatively and on the seventh postoperative day were significantly lower in the bupivacaine group than in the saline group. During tubal ligation, infiltration of uterine tubes and mesosalpinx with 0.5% bupivacaine significantly enhanced analgesia both in the immediate postoperative setting and on the seventh postoperative day compared with infiltration with sodium chloride. IMPLICATIONS: During bilateral tubal ligation with either spinal or epidural anesthesia, preemptive analgesia using IV ketorolac, IV metoclopramide, and infiltration of the incised skin and uterine tubes with 0.5% bupivacaine allowed 9 of 10 patients to recover with no pain, nausea, vomiting, or cramping and to maintain good analgesia for 7 days postoperatively.

Adult↗
PubMed2001

The interaction between intrathecal neostigmine and GABA receptor agonists in rats with nerve ligation Injury.

UNLABELLED: Nerve ligation injury may produce a pain syndrome that includes tactile allodynia. Reversal effects on tactile allodynia have been demonstrated after the intrathecal administration of gamma-aminobutyric acid (GABA) receptor agonists or cholinesterase inhibitors in rats. We examined the drug interactions between neostigmine and muscimol or baclofen in a rat model of nerve ligation injury. Rats were prepared with tight ligation of the left L5-6 spinal nerves and chronic intrathecal catheter implantation. Tactile allodynia was measured by applying von Frey filaments ipsilateral to the lesioned hindpaw. Thresholds for paw withdrawal were assessed. Neostigmine (0.3-10 microg), muscimol (0.1-10 microg), and baclofen (0.1-3.0 microg) were administered to obtain the dose-response curve and the 50% effective dose (ED(50)). Fractions of ED(50) values were administered intrathecally to establish the ED(50)s of drug combinations (neostigmine-muscimol and neostigmine-baclofen). The drug interactions were performed. Intrathecal neostigmine, muscimol, baclofen, and their combinations produced a dose-dependent increase in withdrawal threshold of the lesioned hindpaw. Both analyses revealed a synergistic interaction for the neostigmine-muscimol combination, whereas the effect of the neostigmine-baclofen combination was additive. These results suggest that the activation of both muscarinic and GABA(A) receptors is required for synergistic interaction. IMPLICATIONS: This study indicates that drug interaction is synergistic for the neostigmine-muscimol combination, whereas the effect of the neostigmine-baclofen combination is additive. In a rat model of nerve ligation injury, neostigmine, muscimol, baclofen, and their combinations provide an antagonism on touch-evoked allodynia at the spinal level.

Animals↗
PubMed1989

Pharmacokinetics and disposition of pipecuronium bromide in dogs with and without ligated renal pedicles.

The pharmacokinetics of pipecuronium bromide have been studied in anesthetized beagle dogs with and without ligated renal pedicles. A gas chromatographic assay was used to measure the plasma, urine, bile concentrations, and liver content of pipecuronium, the later of which was obtained 8 h after injection. Following an iv bolus injection of 0.1 mg/kg, pipecuronium disappeared from the plasma exponentially with distribution half-lives of 3.9 +/- 1.1 min and 12.7 +/- 9.5 min (mean +/- SD), and elimination half-lives of 44.8 +/- 2.6 min and 196.7 +/- 102.0 min in animals with and without renal pedicle ligation, respectively. Except for the volume of central compartment, all other pharmacokinetic variables differed significantly between the two experimental groups. The elimination half-life was longer (196.7 +/- 102 (SD) vs. 44.8 +/- 2.6 min), plasma clearance slower (5.9 +/- 0.8 ml.kg-1.min-1 vs. 0.9 +/- 0.1 ml.kg-1.min-1) and mean residence time longer (221 +/- 73 vs. 51.1 +/- 1.8 min) in dogs with ligated renal pedicles. Eight hours after injection, the recovery of the parent form of pipecuronium approximated 77% of the administered dose in the urine, 4.5% in the bile, and 3.3% in the liver of normal animals. In animals with ligated renal pedicles 16% of the unchanged pipecuronium was excreted into the bile and 10% of the administered dose was recovered from the liver. Since the total recovery of unaltered pipecuronium approximated 85% of the administered dose in the intact animals, biotransformation seems to play an insignificant role in disposition of this new neuromuscular blocking drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Androstane-3,17-diol↗
PubMed2003

Intraspinal adenosine induces spinal cord norepinephrine release in spinal nerve-ligated rats but not in normal or sham controls.

BACKGROUND: Intrathecal adenosine is antinociceptive under conditions of central sensitization, but not in response to acute stimuli in normals. The reasons for this selective circumstance of action remain unclear, but some evidence links adenosine's antinociceptive effects to release of norepinephrine by terminals in the spinal cord. The purpose of this study was to test whether spinal adenosine induces norepinephrine release selectively in settings of hypersensitivity. METHODS: Rats randomly assigned to spinal nerve ligation, sham operation, or no operation were anesthetized. A microdialysis fiber was implanted in the spinal cord dorsal horn at the L5-L6 level and perfused with artificial cerebrospinal fluid. After washout and a baseline sample period, adenosine at various concentrations was infused through the fiber for 150 min, and samples were collected every 15 min. RESULTS: In ligated, but not in sham or normal animals, adenosine perfusion increased norepinephrine in spinal cord microdialysates in a concentration-dependent manner. The effects of adenosine plateaued after 75 min and remained stable until the end of the experiment. Intravenous injection of selective adenosine A1 and A2 receptor antagonists revealed that adenosine's effect on spinal norepinephrine release was A1 receptor mediated. CONCLUSIONS: This is the first study to provide direct evidence that adenosine is able to release norepinephrine in spinal cord dorsal horns in living animals. However, this effect was only seen in animals after spinal nerve ligation. These data are consistent with behavioral studies demonstrating that adenosine's antinociceptive effects in rats after spinal nerve ligation is totally dependent on intact spinal noradrenergic terminals and can be blocked by spinal alpha 2-adrenergic receptor antagonists.

Adenosine↗
PubMed1979

Iliac artery ligation: the relative paucity of ischemic sequelae in renal transplant patients.

In order to assess the effect of iliac artery ligation on the distal extremity, the ten year experience of the Johns Hopkins renal transplantation program was reviewed. Among 467 transplant procedures in 390 patients there were six cases in which the common and/or external iliac artery had been ligated for control of untoward hemorrhage from an infected arteriotomy site. These six cases were studied in detail with particular attention to ischemic sequelae in the involved leg. There were no immediate or causally-related deaths. No patient lost a leg or required an immediate reconstructive procedure for limb salvage. Four of the six recovered ambulatory status, and only two of these required a later, elective reconstruction for claudication. The combination of these six with eight other similar patients previously reported provides a total of 14 cases of iliac artery ligation in renal transplant patients. No patient suffered actual limb loss, and only three underwent subsequent elective reconstruction for claudication. It is concluded that common and/or external iliac artery ligation without immediate revascularization may be performed for control of hemorrhage with little danger of limb loss in renal transplant patients.

Adult↗
PubMed1992

Post-ligation dilatation of the fallopian tube.

RATIONALE AND OBJECTIVES: Dilatation of fallopian tube remnants after ligation has been described but never systematically studied in post-ligation hysterosalpingograms (HSGs). This study describes the frequency and appearance of proximal tubal remnant dilatation as seen on HSGs in women with a history of bilateral tubal ligation (BTL). METHODS: A retrospective review of medical records and a subjective and objective evaluation of dilatation seen on HSGs included 68 consecutive women seen for pre-reanastomosis HSG. RESULTS: Among the 68 women, 44 (67%) had objectively measured dilatation on one or both tubes. Dilatation was present in both short and long tubal remnants. There were no measurable differences between women with and without presence of dilatation. Neither length nor dilatation of tubal remnant was associated with pregnancy outcome. CONCLUSIONS: Dilatation of the tubal remnant after bilateral tubal ligation is a common finding on HSG and can be accurately identified from the HSG by radiologists. Dilatation is not strictly related to length, and in our small sample with follow-up, was not associated with pregnancy outcome.

Adolescent↗
PubMed1999

Esophageal variceal ligation by reloading with inexpensive hemorrhoidal O-ring--is an overtube necessary?

The overtube is the major cause for severe complications during endoscopic variceal ligation with a single-shot ligator. This retrospective study was designed to examine the necessity of the placement of an overtube during elective endoscopic variceal ligation. Thirty-one sessions in 18 patients were analyzed. An overtube was inserted using an over-the-scope technique in 11 sessions (group 1) but was omitted in 20 sessions (group II). The complications, technical difficulties, and operating time were analyzed. Child's grading, the size of the esophageal varices, and the number of rubber bands deployed were comparable in both groups. There was a significantly longer operating time (p < 0.01) and more oropharyngeal injury (p = 0.03) in group I than in group II. Mid esophageal injury, which was associated with resistance in withdrawing the gastroscope from the overtube, occurred in 55% of sessions in group I but in 0% of session in group II. In conclusion, the use of an overtube is associated with more complications, and it can be omitted during elective endoscopic variceal ligation.

Case-Control Studies↗
PubMed1988

Ligation as definitive management of injury to the superior mesenteric vein.

Ligation of the injured superior mesenteric vein in patients with multisystem trauma has been regarded as a hazardous procedure with a narrow spectrum of indications. We present three patients who underwent ligation of their superior mesenteric veins. A collective review of 33 superior mesenteric vein ligations and 75 superior mesenteric venorrhaphies indicated that ligation of this vein is indeed a valid option when a simple repair cannot easily be performed.

Adolescent↗
PubMed1995

Long-term results with penile vein ligation for venogenic impotence.

Penile vein ligation for venogenic impotence was performed on 15 patients between 1989 and 1992. Preoperative evaluation included color flow Doppler ultrasound, and dynamic infusion cavernosogram and cavernosometry with vasoactive substance injection. All operations were performed by 1 surgeon via an inguinoscrotal incision by excising the deep dorsal, cavernous and, if necessary, crural veins. All patients were interviewed using a structured telephone questionnaire from 19 to 45 months (mean 29) postoperatively. Postoperative potency was defined as erections sufficient for unaided coitus on more than 75% of attempts and was present in 9 patients (60%). The 2 failures had temporary improvement within the first 6 months. The only significant preoperative variable in assessing postoperative potency was the duration of erectile dysfunction before penile vein ligation: median 60 months (range 48 to 120) in the impotent group and median 24 months (range 12 to 168) in the potent group (p < 0.05, Mann-Whitney test). No correlation was found with systolic and diastolic arterial flow or resistive index as assessed by color flow Doppler evaluation, sites of leakage or patient age at operation. Similarly, no correlation was found with preoperative dynamic infusion cavernosometry maintenance rates. The most common complication was contracture of the penis in 6 patients (40%), although only 1 complained of a functional disturbance. We demonstrated favorable long-term results with an extensive venous ligation. While preoperative assessment with color flow Doppler ultrasound, dynamic infusion cavernosography and cavernosometry, and vasoactive substance injection establishes a diagnosis of corporeal veno-occlusive dysfunction, this evaluation provides no predictive indicators for successful outcomes in penile vein ligation.

Adult↗
PubMed1999

Recanalization and rupture of a giant vertebral artery aneurysm after hunterian ligation: case report.

OBJECTIVE AND IMPORTANCE: Recanalization and subsequent rupture of giant aneurysms of the posterior circulation after Hunterian ligation is an extremely rare event that has been noted to occur with basilar apex, basilar trunk, and vertebrobasilar junction aneurysms. We report the case of a giant, previously unruptured right vertebral artery aneurysm, which recanalized from the contralateral vertebral artery and subsequently ruptured after previously performed angiography showed complete thrombosis of the aneurysm. CLINICAL PRESENTATION: A 72-year-old woman presented with headaches, ataxia, and lower extremity weakness. A giant 3-cm right vertebral artery aneurysm was found during the patient evaluation. INTERVENTION: Because of the size of the aneurysm and the absence of a discrete neck, Hunterian ligation was performed. After treatment, angiograms showed no filling of the aneurysm from either the right or left vertebral artery. Nine days later, after the patient developed lethargy and nausea, repeat angiography showed that a small portion of the aneurysmal base had recanalized. The next day, the patient had a massive subarachnoid hemorrhage and subsequently died. CONCLUSION: We think that this is a previously undescribed complication associated with direct arterial ligation of giant vertebral artery aneurysms. Patients with aneurysms treated using Hunterian ligation need to be followed up closely. Even aneurysms that have minimal recanalization are at risk for subarachnoid hemorrhage.

Aged↗
PubMed1996

Paraplegia resulting from vessel ligation.

STUDY DESIGN: This is a retrospective review of clinical records for evidence of paraplegia specifically resulting from segmental vessel ligation during anterior spinal surgery. OBJECTIVES: To determine the precise risk rate, and to potentially identify risk factors. SUMMARY OF BACKGROUND DATA: Although many authors have alluded to this risk, the exact risk rate and risk factors have never been identified. METHODS: All patients having an anterior approach involving T1-L3 were reviewed. The two reviewers were not involved in any of the surgeries. The 1197 cases were consecutive from 1967 to 1991. RESULTS: There were no paralyses. CONCLUSIONS: There would appear to be virtually no risk to segmental vessel ligation provided: 1) vessel ligation is unilateral, 2) done on the convexity of a scoliosis, 3) ligated at midvertebral body level, and 4) hypotensive anesthesia is avoided. Soft clamping with somatosensory-evoked potential monitoring does not appear justified.

Adult↗