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Sufali et al. Vessel Plus 2024;8:16 Vessel Plus
DOI: 10.20517/2574-1209.2023.139

Original Article Open Access

Results of a multidisciplinary spinal cord ischemia

prevention protocol in elective repair of Crawford’s
extent I-III thoracoabdominal aneurysms by

fenestrated and branched endografts

Gemmi Sufali 1 , Gianluca Faggioli 1,2 , Enrico Gallitto 1,2 , Rodolfo Pini 1,2 , Andrea Vacirca 1,2 ,
Chiara Mascoli 1,2 , Mauro Gargiulo 1,2
1
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy.
2
Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy.
Correspondence to: Dr. Gemmi Sufali, Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of
Bologna, Via Massarenti 9, Bologna 40138, Italy. E-mail: gemmi.sufali@gmail.com

How to cite this article: Sufali G, Faggioli G, Gallitto E, Pini R, Vacirca A, Mascoli C, Gargiulo M. Results of a multidisciplinary
spinal cord ischemia prevention protocol in elective repair of Crawford’s extent I-III thoracoabdominal aneurysms by fenestrated
and branched endografts. Vessel Plus 2024;8:16. https://dx.doi.org/10.20517/2574-1209.2023.139
Received: 24 Oct 2023 First Decision: 16 Jan 2024 Revised: 26 Feb 2024 Accepted: 19 Mar 2024 Published: 27 Mar 2024

Academic Editor: Fabrizio Monaco Copy Editor: Fangyuan Liu Production Editor: Fangyuan Liu

Abstract
Aim: Fenestrated/branched endografting (F/B-EVAR) is an established technique to treat thoracoabdominal aortic
aneurysms (TAAAs) in high-risk patients. Spinal cord ischemia/infarction (SCI) is a possible postoperative
complication leading to deterioration in quality of life and decreased survival. Several strategies have been
suggested in order to minimize its occurrence. The aim of this study was to report the outcomes of a dedicated
multidisciplinary SCI prevention protocol for elective F/B-EVAR in Crawford’s extent I-III TAAAs.

Methods: All consecutive Crawford’s I-III TAAAs undergoing elective F/B-EVAR from 2010 to 2022 (March) in a
single center were prospectively collected and retrospectively analyzed. A dedicated SCI prevention protocol was
always adopted. The protocol included several surgical precautions, such as the collateral arterial network
optimization, the adoption of a staged repair, and the early limbs reperfusion. Routine use of cerebral spinal fluid
drainage (CSFD) was embraced. More anesthesiological measures were the maintenance of perioperative mean
arterial pressure > 80 mm Hg, and blood hemoglobin levels > 10 mg/dL. Neurological measures were constituted
by intraoperative monitoring with motor-evoked (MEPs) and somatosensory-evoked potentials (SSEPs) plus
hourly bedside neurological evaluation during ICU stay. Preoperative comorbidity and postoperative complications
were classified according to the Society of Vascular Surgery Reporting Standards. SCI, cardiac/pulmonary

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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