Features  |   February 2019
Spinal Cord Protection in Thoracic Endovascular Aortic Repair (TEVAR) Surgeries – How Can Anesthesiologists Lead the Way?
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Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Features
Features   |   February 2019
Spinal Cord Protection in Thoracic Endovascular Aortic Repair (TEVAR) Surgeries – How Can Anesthesiologists Lead the Way?
ASA Monitor 2 2019, Vol.83, 16-19.
ASA Monitor 2 2019, Vol.83, 16-19.
The spinal cord is at risk of ischemia or infarction following open or endovascular procedures involving the descending thoracic and thoracoabdominal aorta. The risk of paraplegia or paraparesis following open surgical repair of the thoracoabdominal aortic aneurysms (TAAA) reaches upward of 20 percent.1  As a less invasive procedure, thoracic endovascular aortic repair (TEVAR) minimizes hemodynamic derangements that are typical of an open aortic repair.2  Nonetheless, the associated risk of spinal cord ischemia (SCI) and resultant permanent neurologic injury is not insignificant. The incidence of SCI after TEVAR has been reported to be anywhere between 0 and 10.3 percent.3  Although the reported risk of SCI is lower with TEVAR as compared to an open surgical repair, it is important to recognize that there is significant anatomic heterogeneity between the two repairs. It has been suggested that when the extent of aortic coverage by TEVAR is equivalent to the portion of the aorta replaced by an open repair, the actual risk of SCI is similar between the two patient populations.1  The underlying pathogenesis resulting in SCI is not fully understood but appears to be multifactorial. Moreover, a range of spinal cord protective and monitoring strategies are currently utilized with variable success.
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