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Page 12 of 14 Sufali et al. Vessel Plus 2024;8:16 https://dx.doi.org/10.20517/2574-1209.2023.139

either in open fashion or endovascularly between 2000 and 2013 in 12 Japanese centers, 631 patients
received intraoperative MEPs monitoring and the outcome was compared with the outcome of 583 patients
treated without neuromonitoring. MEPs failed to improve the outcome. The low number of cases
performed under SSEPs/MEPs until 2022 in our department precludes a meaningful consideration of its
role in the secondary prevention of SCI.

This study has limitations primarily concerning its retrospective nature, which includes potential biases
related to data collection and incomplete medical records, and the small size of SCI group that may not fully
represent the broader SCI population, potentially limiting general conclusions. Further research with larger
and more diverse SCI groups is necessary to validate and extend these findings.

In conclusion, dedicated multidisciplinary SCI prevention protocol in elective F/B-EVAR for Crawford’s I-
III TAAAs is feasible and safe, with encouraging rates of SCI (8% overall SCI, 6% permanent impairment
with 3% paraplegia). The 30-day mortality (3%), cardiopulmonary morbidities (6%), and dialysis rate (3%)
were satisfactory, as well as the estimated survival at 3 years (62%). Patients with SCI had a significantly
lower survival (18% vs. 69%) at 2 years.

Further high-quality scientific data are needed to define the role of prophylactic or therapeutic CSFD.
Although defining the efficacy of individual SCI prevention measures is not easy, treatment staging has been
widely associated with lower rate of SCI.

DECLARATIONS
Authors’ contributions
Conception and design: Sufali G, Faggioli G
Analysis and interpretation: Sufali G, Gallitto E, Pini R, Vacirca A
Data collection: Sufali G, Mascoli C
Writing the article: Sufali G
Critical revision of the article: Faggioli G, Vacirca A, Gargiulo M
Final approval of the article: Sufali G, Faggioli G, Gallitto E, Pini R, Vacirca A, Mascoli C, Gargiulo M
Statistical analysis: Sufali G, Pini R
Overall responsibility: Gargiulo M

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Gargiulo M, Faggioli G and Gallitto E are consultants for Cook Medical. The remaining authors declared
that there are no conflicts of interest.

Ethical approval and consent to participate
All patients signed a dedicated consent for both the complex endovascular procedure and the analysis of
their anonymous data. For the present study, data of all patients were extrapolated in a second electronic
database and retrospectively analyzed. The study was performed with the approval of the ethical review
board of IRCCS - Azienda Ospedaliero-Universitaria di Bologna (T.Ev.AAA-155/2015/U/Oss).