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Gomes et al. Vessel Plus 2023;7:24 Vessel Plus
DOI: 10.20517/2574-1209.2023.60

Review Open Access

Strategies for prevention of spinal cord ischemia in

the management of thoracic and thoracoabdominal
aneurysms

Vivian Carla Gomes , Mark A. Farber , F. Ezequiel Parodi

Vascular Surgery Division, Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC
27599-7212, USA.
Correspondence to: Vivian Carla Gomes, Vascular Surgery Division, Department of Surgery, School of Medicine, University of
North Carolina at Chapel Hill, 160 Dental Circle, Burnett-Womack Building, 3rd Floor, Vascular Surgery Division, Chapel Hill, NC
27599-7212, USA. E-mail: vivian-carla_da-silva-gomes@med.unc.edu

How to cite this article: Gomes VC, Farber MA, Parodi FE. Strategies for prevention of spinal cord ischemia in the management
of thoracic and thoracoabdominal aneurysms. Vessel Plus 2023;7:24. https://dx.doi.org/10.20517/2574-1209.2023.60

Received: 10 Jun 2023 First Decision: 11 Sep 2023 Revised: 26 Sep 2023 Accepted: 25 Oct 2023 Published: 30 Oct 2023

Academic Editors: Christopher Lau, Frank W. Sellke Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
Spinal cord ischemia (SCI) is undoubtedly the most devastating adverse event that occurs after either a thoracic
aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA) repair. While open surgery techniques and
minimally invasive endovascular options are now available for treating complex anatomy aortic aneurysms, spinal
cord ischemia still occurs to a greater extent than desirable. Multiple risk factors have been associated with this
adverse event, such as advanced age, perioperative hypotension, extent of the repair, and ligation of multiple
intercostal and lumbar arteries during the surgical repair. The present literature review aims to analyze the
contributing risk factors for SCI in the context of aortic surgery, explore the most relevant strategies for preventing
postoperative SCI, and discuss the current management strategy when this complication occurs.

Keywords: Spinal cord ischemia, thoracic aneurysm, thoracoabdominal aneurysm, TEVAR, F/BEVAR, hypogastric
artery patency, subclavian artery patency, lumbar drain, staged repair

INTRODUCTION
[1]
The incidence of thoracic aortic aneurysms is estimated at 6 cases per 100,000 per year , 40% of them
involving the descending thoracic aorta (TAA) and 10% the thoracoabdominal aorta (TAAA) .
[2]

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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