Strategies to prevent TEVAR-related spinal cord ischemia.
Spinal cord ischemia remains the Achilles' heel of thoracic and thoracoabdominal diseases management. Great improvements in morbidity and mortality have been obtained with the endovascular approach TEVAR (Thoracic Endovascular Aortic Repair) but this devastating complication continues to severely affect the quality of life, even if the primary success of the procedure - dissection/aneurysm exclusion - has been achieved. Several strategies to deal with this complication have been published in the literature over the time. Knowledge and technology have been evolving from identification of the risk factors associated with spinal cord ischemia, including lessons learned from open surgery, and from developments in the collateral network concept for spinal cord perfusion. In this comprehensive review, the authors cover several topics from the traditional measures comprising haemodynamic control, cerebrospinal drainage and neuroprotective drugs, to the staged-procedures approach, the emerging MISACE (minimally invasive selective segmental artery coil-embolization) and innovative neurologic monitoring such as NIRS (near-infrared spectroscopy) of the collateral network.
1 Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal.|3 Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, Portugal.
Marina
M
Dias-Neto
2 Department of Anaesthesiology, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal.
Pedro Videira
PV
Reis
1 Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal.
Dalila
D
Rolim
1 Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal.
José Fernando
JF
Ramos
1 Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal.
José Fernando
JF
Teixeira
1 Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal.|4 Faculty of Medicine, Department of Information and Decision Sciences in Health (CIDES), Research Center in Health Technologies and Information systems (CINTESIS), University of Porto, Alameda Professor Hernani Monteiro, Portugal.
Sérgio
S
Sampaio
D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D003097:Collateral Circulation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D012039:Regional Blood Flow; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome
TEVAR; cerebrospinal fluid drainage; spinal cord ischemia