Is the incidence of spinal cord ischemia different after endovascular thoracic aortic repairs compared to open repairs?
The reported incidence of postoperative neurologic injuries after endovascular thoracic aortic reconstruction is similar to that of open thoracic aortic repair. With descending aortic reconstruction, intercostal arteries that supply the anterior spinal cord may be sacrificed, resulting in spinal cord injury. Probable risk factors for paraplegia include the length of the thoracic endograft placed and a history of previous abdominal aortic aneurysm repair.
Anecdotal evidence exists for the reversal of spinal cord symptoms by cerebrospinal fluid (CSF) drainage after endovascular thoracic aortic repair. In our practice, patients who are judged to be at high risk for postoperative paraplegia (based upon endograft length and history of abdominal aortic aneurysm repair) receive perioperative induced hypertension, CSF drainage, and steroid and man-nitol administration.