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INTERNATIONAL ANGIOLOGY

Rivista di Angiologia


Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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International Angiology 2018 Feb 08

DOI: 10.23736/S0392-9590.18.03960-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Spinal cord injury in endovascular thoracoabdominal aortic aneurysm repair: prevalence, risk factors and preventive strategies

Vítor MIRANDA 1, Joel SOUSA 1, 2 , Armando MANSILHA 1, 2

1 Faculty of Medicine of the University of Porto, Porto, Portugal; 2 Department of Angiology and Vascular Surgery, Hospital de S. João, Porto, Portugal


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Thoracoabdominal aortic aneurysms are among the most challenging pathologic conditions vascular surgeons have to face. Endovascular treatment brought the prospect of being able to treat these complex aneurysms with less invasiveness and recent outcomes already challenge those of open repair. Plus, this technique offers a therapeutic option for patients who had none, due to significant comorbidities limiting open repair. Spinal cord injury is a major complication after complex aneurysm repair that dramatically affects patient’s quality of life, even if technical success - aneurysm exclusion from circulation - has been achieved. Several strategies to prevent this terrible outcome have been developed, with remarkable success in narrowing down the number of patients who will suffer this complication. This comprehensive review covers how the standard of care for thoracoabdominal aortic aneurysms has evolved over time, how the understanding of spinal cord perfusion has changed in light of the collateral network concept, the risk factors associated with SCI, and details preventive strategies applied in current practice to lessen even further the frequency of spinal cord injury. Strategies covered go from the traditional adjuncts comprising haemodynamic control, neuroprotective drugs, neuromonitoring and cerebrospinal fluid drainage to emerging and innovative techniques such as NIRS (near-infrared spectroscopy), two-steps repair, MISACE (minimally invasive selective segmental artery coil-embolization), TASP (temporary aneurysm sac perfusion) and techniques for earlier pelvic and lower limb reperfusion.


KEY WORDS: Thoracoabdominal aortic aneurysm - Endovascular repair - Spinal cord injury - Spinal cord ischemia

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Publication History

Article first published online: February 8, 2018
Manuscript accepted: February 1, 2018
Manuscript received: December 11, 2017

Per citare questo articolo

Miranda V, Sousa J, Mansilha A. Spinal cord injury in endovascular thoracoabdominal aortic aneurysm repair: prevalence, risk factors and preventive strategies. Int Angiol 2018 Feb 08. DOI: 10.23736/S0392-9590.18.03960-3

Corresponding author e-mail

joelferreirasousa@gmail.com