Spinal Cord Protection

Neurologic deficits represent a dramatic complication after thoracic and thoracoabdominal aneurysm repair and are associated with a higher mortality rate. In multicentre series, thoracic endovascular aortic repair (TEVAR) has been associated with lower paraplegia rates compared to open series ranging from 1 to 3 % (Buth et al. 2007; Makaroun et al. 2005; Matsumura et al. 2008). Recent meta-analysis data reported a major neurologic complication of 5.4 % vs. 14 % with a 30 % reduction risk of paraplegia for endografts cohorts (Walsh et al. 2008). Paraplegia pathophysiology was firstly focused on the integrity of the artery of Adamkiewicz (see Fig. 6.1).