title: Spinal cord ischemia is multifactorial: what is the best protocol?
abstract: Despite the improved understanding of spinal cord anatomy and spinal cord ischemia pathophysiology, the rate of debilitating postoperative paraparesis or paraplegia is still not negligible after procedures for thoracic or thoracoabdominal aortic disease. Single studies have demonstrated the role of different treatment modalities to prevent or treat spinal cord ischemia. A multimodal approach, however, is advocated by most authors. Even after the employment of endovascular techniques become routine, the rate of spinal cord ischemia after treatment of thoracoabdominal aortic pathology remained unchanged over time. Spinal cord ischemia is often treatable by different means that concur to improve indirect spinal perfusion through collateral circulation; it should, therefore, be managed promptly and aggressively due to its potential reversibility. Ongoing technical improvements of non-invasive diagnostic tools may allow a better preoperative assessment of the spinal vascular network and a better planning of both open and endovascular thoracic or thoracoabdominal repair.
authors.affiliation: Scientific Institute H. San Raffaele, Chair of Vascular Surgery, "Vita Salute" San Raffaele University, Milan, Italy - melissano.germano@hsr.it.
authors.forename: Germano
authors.initials: G
authors.lastname: Melissano
authors.forename: Luca
authors.initials: L
authors.lastname: Bertoglio
authors.forename: Daniele
authors.initials: D
authors.lastname: Mascia
authors.forename: Enrico
authors.initials: E
authors.lastname: Rinaldi
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Del Carro
authors.forename: Pasquale
authors.initials: P
authors.lastname: Nardelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002985:Clinical Protocols / Q000592:standards*; D057510:Endovascular Procedures / Q000009:adverse effects*; D014943:Global Health; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control