title: Spinal cord protection in open- and endovascular thoracoabdominal aortic aneurysm repair: critical review of current concepts and future perspectives.
abstract: Unresolved for over half a century now since the beginning of aortic surgery spinal cord injury (SCI) remains the most devastating complication after extensive open and endovascular thoracoabdominal aortic aneurysm (TAA/A) repair. Over the past decade extensive research on spinal cord perfusion lead to a better understanding of previously unknown physiologic mechanisms involved in the suspension of the cord's arterial supply and the consecutive development of SCI underscoring the need for new concepts in treatment strategy and monitoring methods during and after TAA/A repair. Based on this knowledge, new treatment strategies in particular the staged-repair were developed. The first-in-man translation of this idea has just been published introducing the new concept: minimally invasive selective segmental artery coil-embolization. Another approach to overcome the most critical initial period after segmental artery occlusion due to stent graft deployment in the descending or thoracoabdominal aorta is temporary aneurysm sac perfusion, which also has recently been clinically trialed. Furthermore, the new non-invasive real-time monitoring method to record spinal cord viability by means of near-infrared spectroscopy of the paraspinal collateral network by means of near-infrared spectroscopy has also been suggested and successfully introduced in a pilot series to a clinical setting. This review addresses problems, unsolved questions and future perspectives regarding these three new concepts.
authors.affiliation: Department of Cardiac Surgery, University Heart Center Leipzig, Leipzig, Germany - Konstantin.Aspern@Helios-Kliniken.de.
authors.forename: K
authors.initials: K
authors.lastname: Von Aspern
authors.forename: M
authors.initials: M
authors.lastname: Luehr
authors.forename: F W
authors.initials: FW
authors.lastname: Mohr
authors.forename: C D
authors.initials: CD
authors.lastname: Etz
mesh_terms: D000818:Animals; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods; D011237:Predictive Value of Tests; D012307:Risk Factors; D019265:Spectroscopy, Near-Infrared; D013116:Spinal Cord / Q000098:blood supply*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D020760:Spinal Cord Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome