Strategies for prevention and treatment of spinal cord ischemia during F/BEVAR.

Spinal cord ischemia (SCI) after endovascular aortic repair is associated with significant morbidity and mortality. Understanding of the pathogenesis and physiologic mechanisms of SCI dictates prevention and treatment when neurologic deficits occur. Currently used or proposed preventive modalities include staged repair, temporary aneurysm sac perfusion, segmental artery embolization, and management of hemodynamic parameters based on decades of experience with open thoracoabdominal and thoracic endovascular aortic repair. The role of cerebrospinal fluid drainage in prevention of SCI remains an area of clinical equipoise. "Rescue maneuvers" when neurologic deficits develop are generally consistent and include cerebrospinal fluid drainage, hemodynamic management, and elevated hemoglobin goals. The role of team communication and education in expedient recognition and treatment initiation in SCI is paramount. Advances in spinal cord protective practices and new therapies in spinal cord injury may play a role in future prevention and treatment protocols. Additional research is needed to further define the optimal use of currently accepted and emerging therapies, and current management practices, to improve patient outcomes with regard to SCI after branched and fenestrated endovascular aortic repair.