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Review
. 2023 Sep 28;12(5):438-449.
doi: 10.21037/acs-2023-scp-08. Epub 2023 May 15.

Spinal cord protection for thoracoabdominal aortic aneurysm repair: from bench to bedside

Adam M Carroll  1 , R Wilson King  1 , Christian V Ghincea  1 , Muhammad Aftab  1 , T Brett Reece  1
Affiliations
Review

Spinal cord protection for thoracoabdominal aortic aneurysm repair: from bench to bedside

Adam M Carroll et al. Ann Cardiothorac Surg. .

Abstract

This keynote lecture and corresponding presentation discuss the anatomy and pathophysiology surrounding spinal cord injury in aortic surgery. This article will discuss risk factors and mechanisms for spinal cord injury, including loss of direct and collateral spinal cord perfusion and ischemia-reperfusion injury. This review will examine these elements in both the laboratory and clinical setting, in addition to other neuroprotective strategies applied in clinical practice. Addressing spinal cord injury requires an integrated and considerate approach to simultaneously optimize spinal cord blood flow, promote collateralization and improve ischemic tolerance. Given the catastrophic clinical consequences for both the patient and their caregivers, continuing to investigate and examine spinal cord injury is of the utmost importance.

Keywords: Spinal cord ischemia; aortic aneurysm; collateral circulation; neuroprotection.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Decreased spinal cord perfusion and increasing ischemia leads to higher severity of injury. Adapted from Ghincea et al. (1). SCI, spinal cord injury.
Figure 2
Figure 2
Global blood flow to the spinal cord.
Figure 3
Figure 3
Spinal cord blood flow at the level of the distal thoracic or proximal abdominal aorta where the artery of Adamkiewicz can be found in a majority of patients. Figure from open source image by Linderie & Hauser (7).
Figure 4
Figure 4
Spinal cord injury prevention adapted from Tanaka et al. & Ghincea et al. (1,36). SCI, spinal cord injury; CSF; cerebrospinal fluid; MAP, mean arterial pressure; SA, segmental artery; ICU, intensive care unit; Hgb, hemoglobin; SpO2, oxygen saturation.
Video
Video
Spinal cord protection for thoracoabdominal aortic aneurysm repair: from bench to bedside.
See this image and copyright information in PMC

References

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