AI Article Synopsis
- TEVAR (thoracic endovascular aortic aneurysm repair) is a common treatment for thoracic aortic issues, but it poses risks for spinal cord injury (SCI).
- The review discusses the current understanding of risk factors and the complex pathophysiology of SCI, noting that delayed paralysis is more common after TEVAR compared to open surgery.
- Strategies for preventing SCI include cerebrospinal fluid drainage, managing blood pressure, and the use of advanced surgical techniques, with a call for more research to develop better protective methods.
Article Abstract
Purpose: Thoracic endovascular aortic aneurysm repair (TEVAR) has become a mainstay of therapy for aneurysms and other disorders of the thoracic aorta. The purpose of this narrative review article is to summarize the current literature on the risk factors for and pathophysiology of spinal cord injury (SCI) following TEVAR, and to discuss various intraoperative monitoring and treatment strategies.
Source: The articles considered in this review were identified through PubMed using the following search terms: thoracic aortic aneurysm, TEVAR, paralysis+TEVAR, risk factors+TEVAR, spinal cord ischemia+TEVAR, neuromonitoring+thoracic aortic aneurysm, spinal drain, cerebrospinal fluid drainage, treatment of spinal cord ischemia.
Principal Findings: Spinal cord injury continues to be a challenging complication after TEVAR. Its incidence after TEVAR is not significantly reduced when compared with open thoracoabdominal aortic aneurysm repair. Nevertheless, compared with open procedures, delayed paralysis/paresis is the predominant presentation of SCI after TEVAR. The pathophysiology of SCI is complex and not fully understood, though the evolving concept of the importance of the spinal cord's collateral blood supply network and its imbalance after TEVAR is emerging as a leading factor in the development of SCI. Cerebrospinal fluid drainage, optimal blood pressure management, and newer surgical techniques are important components of the most up-to-date strategies for spinal cord protection.
Conclusion: Further experimental and clinical research is needed to aid in the discovery of novel neuroprotective strategies for the protection and treatment of SCI following TEVAR.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954412 | PMC |
| http://dx.doi.org/10.1007/s12630-017-0974-1 | DOI Listing |
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