Prevention of paraplegia during thoracoabdominal aortic aneurysm repair.
Paraplegia affects up to 22% of patients undergoing thoarcoabdominal aneurysm surgery, producing long-term morbidity and a significant burden to healthcare. This article discusses the mechanisms that may lead to paraplegia during open and endovascular repair from an anatomical and physiological perspective. There are many adjuncts that must be considered to reduce the risk of spinal cord injury, such as revascularisation of intercostal arteries, maintenance of high mean blood pressure, spinal cord drainage and cooling. These adjuncts are discussed, highlighting the evidence available for each method and the practical ways in which they may be used.
Regional Vascular Unit, St Mary's Hospital, Imperial College London, UK. colin.bicknell@ic.ac.uk
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Bicknell
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Riga
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Wolfe
D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D004322:Drainage; D006439:Hemodynamics; D006801:Humans; D007036:Hypothermia, Induced; D016343:Monitoring, Intraoperative; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010477:Perfusion / Q000379:methods; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation