The incidence of
spinal cord injury in
thoracic endovascular aortic repair (
TEVAR) has been 3-5 % from recent major papers where sacrifice of the critical intercostal arteries is inevitable by a
stent graft. Hemodynamic stability, which depends on a network of blood vessels around the cord is most important not only during but also after
stent-graft deployment. High risk factors of
spinal cord injury during
endovascular aortic repair are (1) coverage of the left subclavian artery, (2) extensive coverage of long segments of the thoracic aorta, (3) prior downstream aortic repair, (4) compromising important intercostal (T8-L1), vertebral, pelvic and hypogastric collaterals, and (5) shaggy aorta. Preoperative, intraoperative, and postoperative managements have been required to prevent
spinal cord injury with
TEVAR. For imaging assessment of blood supply to spinal cord including Adamkiewicz artery, prophylactic
cerebrospinal fluid drainage is mandatory, and monitoring motor-evoked potential is recommended for high risk factors of
spinal cord injury. Mean arterial pressure should be maintained over 90 mmHg after
stent-graft placement for a while to prevent delayed
spinal cord ischemia in high-risk patients of
spinal cord ischemia. Finally, because
spinal cord injury during
TEVAR is not rare and negligible,
perioperative care during
TEVAR should be strictly performed according to the protocol proposed by each cardiovascular team.