Spinal cord protection in aortic endovascular surgery

Area of Science:

• Vascular Surgery
• Neurology
• Neurosurgery

Background:

• Spinal cord injury (SCI) is a significant complication following descending thoracic and abdominal aortic surgery.
• Despite advances in imaging and endovascular techniques, the risk of SCI persists, particularly with extensive aortic repair procedures.

Observation:

• Extensive fenestrated endovascular aortic graft prostheses carry up to a 10% risk of SCI.
• Patients undergoing extensive thoracic, abdominal, and pelvic aortic stenting are at the highest risk.

Findings:

• Lumbar cerebrospinal fluid drainage is a common intervention to protect the spinal cord.
• Maintaining adequate perfusion pressure and considering staged procedures are crucial strategies.

Implications:

• Identifying high-risk patients and implementing protective strategies are essential.
• Further research is needed on spinal cord monitoring, cooling, pharmacological protection, and optimal intervention duration.