Spinal cord ischemia is multifactorial: what is the best protocol?

Abstract

Despite the improved understanding of spinal cord anatomy and spinal cord ischemia pathophysiology, the rate of debilitating postoperative paraparesis or paraplegia is still not negligible after procedures for thoracic or thoracoabdominal aortic disease. Single studies have demonstrated the role of different treatment modalities to prevent or treat spinal cord ischemia. A multimodal approach, however, is advocated by most authors. Even after the employment of endovascular techniques become routine, the rate of spinal cord ischemia after treatment of thoracoabdominal aortic pathology remained unchanged over time. Spinal cord ischemia is often treatable by different means that concur to improve indirect spinal perfusion through collateral circulation; it should, therefore, be managed promptly and aggressively due to its potential reversibility. Ongoing technical improvements of non-invasive diagnostic tools may allow a better preoperative assessment of the spinal vascular network and a better planning of both open and endovascular thoracic or thoracoabdominal repair.

• Authors: Germano Melissano, Luca Bertoglio, Daniele Mascia, Enrico Rinaldi, Ubaldo Del Carro, Pasquale Nardelli, Roberto Chiesa
• Journal: The Journal of cardiovascular surgery (J Cardiovasc Surg (Torino)) Vol. 57 Issue 2 Pg. 191-201 (Apr 2016) ISSN: 1827-191X [Electronic] Italy
• PMID: 26731537 (Publication Type: Journal Article, Review)

Topics

• Aortic Aneurysm, Thoracic (surgery)
• Blood Vessel Prosthesis Implantation (adverse effects)
• Clinical Protocols (standards)
• Endovascular Procedures (adverse effects)
• Global Health
• Humans
• Incidence
• Postoperative Complications
• Spinal Cord (blood supply)
• Spinal Cord Ischemia (epidemiology, etiology, prevention & control)