Preventing spinal cord ischemia: what really matters

Exclusively interviewed for PVI at Critical Issues 2026, Dr. Daniela Branzan addresses one of the most feared complications of extensive thoracoabdominal aortic repair: spinal cord ischemia. With rates reaching up to 20% in complex cases, its impact on survival and quality of life remains significant. 

Beyond patient-related risk factors, such as hypertension, hypovolemia, renal insufficiency, and the extent of aortic coverage, procedural strategy plays a central role. 

Dr. Branzan emphasizes the importance of a comprehensive protection protocol, starting with careful preoperative planning and assessment of spinal cord perfusion. 

Staged approaches are key, including techniques such as preliminary thoracic endografting, leaving temporary perfusion branches, or performing MISACE prior to definitive repair. 

The final exclusion of the thoracoabdominal aneurysm is typically completed after an interval of several days. 

Equally critical are strict hemodynamic management—favoring permissive hypertension—and close postoperative monitoring in the ICU for at least 48 hours. 

Altogether, these combined measures form a structured strategy to effectively reduce the risk of spinal cord ischemia.

A practical framework for a high-stakes complication: watch now to see how each step fits together!