Spinal cord perfusion protection for thoraco-abdominal aortic aneurysm surgery

Purpose of Review Spinal cord ischemia (SCI) is a devastating complication after open or endovascular aortic repair for thoracoabdominal aortic disease. The underlying pathogenesis is not fully understood but appears multifactorial. Multiple spinal cord protection strategies and monitoring techniques are currently utilized with variable results seen. The purpose of this review is to summarize important and recent findings related to cause, monitoring and impact of multiple spinal cord protection strategies. Recent Findings Recent data suggests collateral blood flow as the major determinant of spinal cord perfusion instead of individual intercostal vessels, potential role of transcutaneous near-infrared spectroscopy for monitoring of spinal cord perfusion and positive impact of implementing multimodal spinal cord protection strategies on reducing the risk of SCI. Summary SCI leading to paraplegia is a multifactorial complication that remains a major concern in complex aortic surgeries. Although there are no sufficient data to document the efficacy of spinal cord protection techniques individually, their effect on lowering the risk of SCI is most evident when used concomitantly using a multimodal approach that encompasses the perioperative and early postoperative period. Correspondence to Lovkesh Arora, MD, 200 Hawkins drive, 6JCP, Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1079, USA. Tel: +1 319 384 6079; e-mail: Lovkesh-arora@uiowa.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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