Spinal cord preservation in thoracoabdominal aneurysm repair.

Spinal cord injury (SCI) stands as one of the most dreadful complications of thoracoabdominal aneurysm repair. Despite the less invasive nature and recent technical advancements of endovascular aortic repair, SCI still remains a significant danger in endovascular approaches. However, as our understanding of the collateral network of spinal cord vasculature has grown, it has become evident that the incidence of paraplegia and paraparesis in conjunction with endovascular procedures can be minimized through the use of many of the same strategies that have proven successful in reducing SCI associated with open surgical repair.

Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept.

In the last two decades, as an increasing number of patients with descending thoracic and thoracoabdominal aneurysms are being diagnosed and treated, a more sophisticated understanding of spinal cord perfusion has become important in the attempt to minimize the frequency of spinal cord injury. The synthesis of information from laboratory studies and clinical experience has led to the collateral network concept, a framework for understanding spinal cord perfusion and thereby improving spinal cord protection during treatment of aneurysmal disease of the aorta distal to the left subclavian artery. Application of principles based on the collateral network concept has resulted in falling rates of spinal cord injury, which now approach 1% in descending thoracic aneurysm resection and less than 10% in extensive thoracoabdominal resections.