Spinal cord protection and related complications in endovascular management of B dissection: LSA revascularization and CSF drainage.

Abstract

The endovascular repair of thoracic aorta (TEVAR) has significantly decreased the overall incidence of neurologic complications when compared with open surgery. Nevertheless, the risk of paraplegia remains an important concern, with rates ranging from 2% up to 8% (1). Risk factors for spinal cord ischemia following TEVAR include prior abdominal aortic aneurysm (AAA) repair, prolonged hypotension, severe atherosclerosis of the thoracic aorta, occlusion of the left subclavian artery (LSA) or hypogastric arteries, and more extensive coverage of the thoracic aorta by the graft (1). Different strategies have been developed over time to protect the spinal cord from ischemic insult during thoracic aortic repair (2) (see Table 1). LSA revascularization and cerebral spinal fluid (CSF) drainage are the two more invasive preventive maneuvers applied in TEVAR for treating type B dissection which may be associated with relevant pitfalls. Table 1 Suggested strategies for spinal cord protection during TEVAR Preoperative Assessment of collateralization Main medullar artery identification Intraoperative Left subclavian artery revascularization Spinal perfusion pressure monitoring Cerebral spinal fluid drainage Increase of hemoglobin levels Increase of mean arterial pressure Evoked potentials monitoring Local or systemic hypothermia Open in a separate window TEVAR, endovascular repair of thoracic aorta.