title: Spinal cord protection in aortic endovascular surgery.
abstract: A persistent neurological deficit, such as paraplegia or paraparesis, secondary to spinal cord injury remains one of the most feared complications of surgery on the descending thoracic or abdominal aorta. This is despite sophisticated advances in imaging and the use of less invasive endovascular procedures. Extensive fenestrated endovascular aortic graft prostheses still carry a risk of spinal cord injury of up to 10%; thus, this risk should be identified and strategies implemented to protect the spinal cord and maintain perfusion. The patients at highest risk are those undergoing extensive thoracic aortic stenting including thoracic, abdominal, and pelvic vessels. Although many techniques are available, lumbar cerebrospinal fluid drainage remains the most frequent intervention, along with maintenance of perfusion pressure and possibly staged procedures to allow collateral vessel stabilization. Many questions remain regarding other technical aspects, spinal cord monitoring and cooling, pharmacological protection, and the optimal duration of interventions into the postoperative period.
authors: University of Melbourne, Parkville, VIC 3052, Australia Department of Anaesthesia and Acute Pain Medicine david.scott@svha.org.au.
authors: D A
authors: DA
authors: Scott
authors: University of Melbourne, Parkville, VIC 3052, Australia Vascular Surgical Unit, St Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, VIC 3065, Australia.
authors: M J
authors: MJ
authors: Denton
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D004322:Drainage; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016343:Monitoring, Intraoperative; D010477:Perfusion; D015427:Reperfusion Injury / Q000517:prevention & control; D013116:Spinal Cord / Q000098:blood supply; D013119:Spinal Cord Injuries / Q000517:prevention & control*; D020760:Spinal Cord Ischemia / Q000517:prevention & control
keywords: aortic aneurysm; cerebrospinal fluid; interventional; radiography; spinal cord injuries; vascular surgical procedures