Pathophysiology of paraplegia following endovascular thoracic aortic aneurysm repair

Paraplegia following endovascular repair of thoracic aortic aneurysms suggests a more crucial role of adequate collateral blood supply to the spinar cord. Patients requiring increasing lengths of thoracic aortic coverage, prior aortic replacement, and those with concomitant abdominal aortic surgery appear to be at greater risk of spinal cord ischemia. The true benefit of preoperative imaging and intraoperative testing to identify critical spinal cord blood supply, cerebral spinal fluid drainage, and pharmacologic adjuncts remains to be determined as more experience accumulates.