Prophylaxis Against Spinal Cord Ischaemia with Thoracic Endovascular Aortic Repair

Case Study

Abstract

Thoracic endovascular aortic repair [TEVAR] involves the placing of a stent-graft introduced via a distal artery to treat a variety of problems affecting the aorta. Here we will consider a patient admitted with ruptured aortic dissection and who following this procedure became paraplegic as a result of spinal cord ischaemia [SCI]. We shall discuss [a] the incidence of SCI with TEVAR, [b] the mechanisms by which TEVAR produces SCI, and [c] how based on this understanding we might best prevent such devastating complications. In particular, we shall focus on the role of cerebrospinal fluid drainage in protecting against ischaemia, as was used in our patient.