Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Sep 28;12(5):429-437.
doi: 10.21037/acs-2023-scp-10. Epub 2023 May 4.

Current approaches to spinal cord protection during open thoracoabdominal aortic aneurysm repair

Joseph S Coselli  1   2   3 , Scott A LeMaire  1   2   3 , Vicente Orozco-Sevilla  1   2   3 , Ourania Preventza  1   2   3 , Marc R Moon  1   2   3 , Lauren M Barron  1   2   3 , Subhasis Chatterjee  1   2   4
Affiliations
Review

Current approaches to spinal cord protection during open thoracoabdominal aortic aneurysm repair

Joseph S Coselli et al. Ann Cardiothorac Surg. .

Abstract

Spinal cord deficit (SCD) is a feared complication after thoracoabdominal aortic aneurysm repair. Vigilant management throughout the perioperative period is necessary to reduce the risk of SCD. Measures for preventing SCD during the intraoperative period include preoperative optimization and recognizing patients at a higher risk of SCD. In this manuscript, we discuss intraoperative adjuncts including utilization of cerebrospinal fluid drainage, left heart bypass, mild hypothermia, selective reimplantation of intercostal and lumbar arteries, and renal and visceral vessel perfusion. From the operative to the postoperative period, careful attention to avoiding hypotension and anemia is important. If SCD is recognized early, therapeutic intervention may be implemented to mitigate injury.

Keywords: Spinal cord; aortic aneurysm; perioperative care; thoracoabdominal.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: JSC participates in clinical studies with and/or consults for Terumo Aortic, Medtronic, W. L. Gore & Associates, CytoSorbents, Edwards Lifesciences, and Abbott Laboratories and receives royalties and grant support from Terumo Aortic. SAL consults for Terumo Aortic and Cerus and serves as a principal investigator for clinical studies sponsored by Terumo Aortic and CytoSorbents. SAL’s work is supported in part by the Jimmy and Roberta Howell Professorship in Cardiovascular Surgery at Baylor College of Medicine. OP provides consultation for and participates in clinical trials with Medtronic and W.L. Gore & Associates. MRM serves on the advisory board for Medtronic and Edwards Lifesciences. SC has served on advisory boards for Edwards Lifesciences, La Jolla Pharmaceutical Company, Eagle Pharmaceuticals and Baxter Pharmaceuticals. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Risks of mortality and major morbidity by extent of thoracoabdominal aortic aneurysm repair. Used with permission (2).
Figure 2
Figure 2
Spinal cord vulnerability in relationship to the anatomy of the thoracoabdominal aorta. A native patch of aorta reattaches selected intercostal arteries between T7/8 and L1/2. Used with permission of Baylor College of Medicine. a., artery; aa., arteries.
Figure 3
Figure 3
Management approach for delayed paraplegia after thoracoabdominal aortic aneurysm repair. Used with permission (30). TAAA, thoracoabdominal aortic aneurysm; MAP, mean arterial pressure; CSF, cerebrospinal fluid; IV, intravenous; CVP, central venous pressure; PADP, pulmonary diastolic pressure.
Video
Video
Current approaches to spinal cord protection during open thoracoabdominal aortic aneurysm repair.
See this image and copyright information in PMC

References

    1. Crawford ES, Crawford JL, Safi HJ, et al. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg 1986;3:389-404. 10.1067/mva.1986.avs0030389 - DOI - PubMed
    1. Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg 2016;151:1323-37. 10.1016/j.jtcvs.2015.12.050 - DOI - PubMed
    1. Gaudino M, Khan FM, Rahouma M, et al. Spinal cord injury after open and endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms: A meta-analysis. J Thorac Cardiovasc Surg 2022;163:552-64. 10.1016/j.jtcvs.2020.04.126 - DOI - PubMed
    1. Chatterjee S, Casar JG, LeMaire SA, et al. Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 1: Preoperative considerations. J Thorac Cardiovasc Surg 2021;161:693-8. 10.1016/j.jtcvs.2019.11.142 - DOI - PubMed
    1. Coselli JS, de la Cruz KI, Preventza O, et al. Extent II thoracoabdominal aortic aneurysm repair: How I do it. Semin Thorac Cardiovasc Surg 2016;28:221-37. 10.1053/j.semtcvs.2016.07.005 - DOI - PubMed