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Katz et al. Vessel Plus 2023;7:1 https://dx.doi.org/10.20517/2574-1209.2022.52 Page 9 of 16

Figure 3. Postoperative considerations by organ system for therapeutic goals and interventions after TAAA or DTA repair.
[2]
CSF: Cerebrospinal fluid; DTA: descending thoracic aneurysm; TAAA: thoracoabdominal aortic aneurysm. Reprinted from the ref. , with
permission from Elsevier.

decreased to 9.6%, and only 2.9% of patients developed persistent paraplegia .
[7]
It is critical to ensure adequate volume resuscitation (as guided by central venous or pulmonary artery
diastolic pressure) in these patients, particularly those with high blood loss. Evaporative or third-space
losses during surgery are often underestimated, and this is particularly true for TAAA repair, which involves
a large incision with viscera and lung exposed for several hours. The postoperative MAP goal varies among
institutions; our usual goal for these patients is 85-100 mmHg, once any significant bleeding has been
controlled .
[38]
Any postoperative neurological deficit portending possible spinal cord injury warrants a further increase in
SCPP by increasing MAP, which necessitates frequent CSF drainage (in 10 mL/h aliquots, not to exceed
150 mL/day or 25 mL/4 h) as well as MAP augmentation with vasopressors. If spinal cord injury is
suspected, we implement the following specific maneuvers: (1) the CSF pressure should be kept low (we aim
for < 15 mmHg); (2) the SCPP should be kept at > 80 mmHg, with a MAP closer to 100 mmHg (if
necessary, MAP can be increased with either volume infusion or vasopressor administration); (3)
dexamethasone 10 mg every 12 h is given intravenously for 2 days, as is mannitol 12.5 g; and (4) if
hemoglobin is < 10 g/dL, packed red blood cells should be transfused to raise the level to 10 g/dL. See
Figure 4 . If a CSF drain is present, drainage is done immediately. If no CSF drain is present, one is
[2]
promptly inserted. In addition to dexamethasone and mannitol, adjuncts such as lidocaine and magnesium
sulfate can be administered. Other centers have published similar management protocols for managing