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Ischemia of the spinal cord in aortic surgery


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Spinal cord ischemia remains the most impressive and colliding complication following open surgical and endovascular aortic procedures. Paraparesis and paraplegia are devastating, having a major invalidating impact on the patient’s life. For the surgeon and the entire team this dramatic adverse event causes a significant concussion.
The author has compiled all available knowledge, information, research and clinical data on spinal cord ischemia after aortic surgery. Following historical reflections he describes the classical anatomy theory, originally addressed by Adamkiewicz. The differences between acute and delayed paraplegia have extensively been explained, including the different strategies to minimize cord ischemia. The author also describes the techniques to assess spinal cord integrity, preconditioning and the approaches to increase and develop collateral pathways. Finally, he discusses the experience after endovascular treatment of descending and thoraco-abdominal aortic aneurysms as well as measures to reduce the incidence of spinal cord ischemia. This book is a comprehensive overview on spinal cord ischemia following aortic procedures and helps in understanding the complexity of the puzzle. It also motivates to continue basic and clinical research in the battle against this terrible medical complication.
Vascularization of the spinal cord

Classical anatomical theory
Concept of collateral network
Biglioli’s theory
Pathophysiology of blood flow through the spinal cord
Physiology of blood flow
Watershed zone concept
Pathology of the spinal cord infarct
Aortic cross clamp
Blood pressure
Pressure of the cerebrospinal fluid
Steal phenomenon
Presurgical assessment of the spinal cord vascularization
Angiographic assessment of intercostal arteries
CT angiography
MR angiography
Etiology of spinal cord ischemia
Initial experimental studies
Acute paraplegia
Delayed paraplegia
Protection of the spinal cord
Techniques for reducing the duration of ischemia of the medulla
Techniques for the preservation of the spinal flow
Techniques for increasing the tolerance to ischemia
Techniques to optimize spinal cord perfusion
Techniques for early detection of spinal cord ischemia
Techniques for spinal cord ischemic preconditioning
Spinal ischemia in application of TEVAR methods
Risk factors for spinal cord ischemia after the application of TEVAR methods
Mechanisms of spinal cord ischemia in TEVAR
Coverage of the left subclavian artery
Prevention of spinal cord ischemia during TEVAR
Spinal cord ischemia in abdominal aortic surgery
Clinical image of medullary infarction

Anterior spinal artery syndrome
Posterior spinal artery syndrome
Postsurgical diagnostics

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