title: Novel approaches to spinal cord protection during thoracoabdominal aortic interventions.
abstract: OBJECTIVE
  Spinal cord ischemia after thoracoabdominal aortic interventions is a devastating complication because it significantly worsens the perioperative morbidity and mortality. Long-term outcome is also affected because of medical complications which are directly related to the neural deficits. Paraplegia has significant medical, social, and financial aspects. Limited mobility, the need for assistance in activities of daily living, makes paraplegia an important target for prevention. An understanding of spinal cord blood supply, risk factors for spinal ischemia, and strategies for spinal cord rescue in this setting can help minimize the negative outcome effects of this important complication.
  
  
  RESULTS
  The vascular supply of the spinal cord is via an extensive collateral arterial network with multiple auxiliary arterial supplies. Risk factors for spinal cord ischemia include extensive aortic repair, prior aortic repair, spinal cord malperfusion on clinical presentation, systemic hypotension, acute anemia, prolonged aortic clamping, and vascular steal. Spinal rescue strategies include systemic hypothermia, endovascular aortic repair, permissive systemic hypertension, cerebrospinal fluid drainage, pharmacologic neuroprotection, and intensive neuromonitoring.
  
  
  CONCLUSIONS
  The progression of spinal cord ischemia after thoracoabdominal aortic interventions can frequently be arrested before irreversible infarction results. This spinal cord rescue depends on the early detection and immediate multimodal intervention to maximize spinal cord oxygen supply. The devastating outcomes associated with spinal infarction in this setting offset the risks and knowledge gaps currently associated with contemporary interventions.
authors: aDepartment of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania bDepartment of Anesthesiology, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York, USA cDepartment of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel.
authors: John G T
authors: JG
authors: Augoustides
authors: Marc E
authors: ME
authors: Stone
authors: Benjamin
authors: B
authors: Drenger
mesh_terms: D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D018696:Neuroprotective Agents / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D012307:Risk Factors; D013116:Spinal Cord / Q000098:blood supply / Q000502:physiology; D013119:Spinal Cord Injuries / Q000517:prevention & control*; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*
chemical_list: D018696:Neuroprotective Agents