Ischaemic Spinal Cord Injury Following Thoracoabdominal Aneurysm Surgery

  • P. de Haan
  • J. Kesecioglu
Conference paper


Thoracoabdominal or descending thoracic aneurysm surgery carries the risk of ischaemic spinal cord injury. Since the appearance of thoracoabdominal reconstructions in the early 1950’s, the risk of paraplegia or paraparesis was soon recognized as a complication of these procedures. The paradigm for paraplegia causation, the interruption of the de-segmented blood supply to the anterior spinal artery, was established by Adams [1]. The extent of the aneurysm was found to be a significant predictor of spinal cord injury. Crawford classified thoracoabdominal aortic aneurysms (TAAA) as follows: type I involves the descending thoracic and upper abdominal aorta; type II includes the entire descending aorta and the abdominal aorta below the renal arteries, and is the most extensive; type III includes less then half of the descending thoracic aorta and most of the abdominal aorta; and type IV involves most or all of the abdominal aorta [2]. In 1 509 patients who had undergone repair for the treatment of thoracoabdominal aortic disease, Svensson found that type I, II, III, and IV aneurysms were associated with lower extremity neurological deficit rates of 15%, 31%, 7%, and 4% respectively [3]. The incidence of overall neurological deficits in that series was 16 %. In another large series of patients, which were equally distributed between types I to IV aneurysms, the long-term survivors (30 days) had a 4.4 % incidence of paraplegia and a 5% incidence of paraparesis [2]. In contrast, after elective abdominal aortic aneurysms surgery the incidence of lower extremity neurological deficits was 0.16–0.25 % [4, 5]. Repair of aneurysms confined to the descending thoracic aorta resulted in paraplegia in 6.5 % of the patients [6]. Despite recent advances in the treatment of thoracoabdominal aneurysms, postoperative paraparesis or paraplegia re- mains a distinct possibility after an otherwise successful operation. Variables predictive of neurologic deficits of the lower extremities include aortic clamp time, the presence of rupture or dissection, the extent of aneurysm, a history of smoking, postoperative hypotension, and age [2, 3, 7, 8].


Thoracoabdominal Aortic Aneurysm Spinal Cord Blood Flow Thoracoabdominal Aneurysm Left Heart Bypass Aortic Crossclamping 
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Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • P. de Haan
    • 1
  • J. Kesecioglu
    • 2
  1. 1.Department of AnaesthesiologyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  2. 2.Department of Intensive CareUniversity of Amsterdam, Academic Medical CentreAmsterdamThe Netherlands

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