[Non-traumatic dissection of the thoracic aorta. A review with special emphasis on postoperative paraplegia]

Non-traumatic dissection of the thoracic aorta is a degenerative vascular disease with a high morbidity and mortality. The main symptom is stabbing thoracic pain, but the diagnosis is made difficult when the clinical picture is dominated by symptoms caused by the aorta's neighbouring structures. The definitive diagnosis is made by aortography. Treatment and prognosis depend on the anatomic placement of the dissection. In dissection of the ascending aorta (type A) the treatment is solely surgical, whereas a combined medical and surgical treatment is recommended for dissections of the descending aorta (type B). The most common postoperative complication in type B dissection is paraplegia, which occurs in up to 40% of cases. The cause of paraplegia is postoperative ischaemia of the spinal medulla. Many methods and treatments have been used to avoid medullary ischaemic damage. The most important ones are reducing the time length of aortic clamping, maintaining an adequate perfusion pressure, and the use of moderate hypothermia. Spinal drainage with or without pharmacological intervention possibly has a preventive effect, but convincing clinical documentation is lacking.