Spinal cord ischemia in TEVAR – Cardiology MCQ

Measures to prevent spinal cord ischemia in TEVAR (thoracic endovascular repair of aortic aneurysm):
a) Avoiding blockage of left subclavian
b) Surgical graft to left subclavian before TEVAR
c) Pre procedure drainage of CSF (cerebrospinal fluid)
d) All of the above
Correct answer: d) All of the above
Spinal cord ischemia manifesting as paraplegia is one of the important complications of TEVAR (thoracic endovascular repair of aortic aneurysm). Avoiding blockage of left subclavian which gives branches which eventually supply the spinal cord is a preventive option in elective setting. In cases in which left subclavian needs to over stented,  a hybrid procedure with a surgical graft to the vessel likely to be blocked being placed before TEVAR is an option. Pre procedure drainage of CSF (cerebrospinal fluid) can be useful as it has been proven useful in aortic surgery for protection of spinal cord. CSF drainage is an immediate option for reversal of paraplegia if it does occur unfortunately. Other option is to raise the blood pressure with mean around 90 mm Hg. Episodes of hypotension should be prevented as far as possible to prevent spinal cord ischemia.
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Source: Cardiophile MD - November 4, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology MCQ DM / DNB Cardiology Entrance Peripheral Interventions Source Type: blogs