Open surgery of thoracoabdominal aortic aneurysm

Postoperative paraplegia is a serious complication of reconstructive surgery on the thoracoabdominal or descending thoracic aorta, and the major cause is thought to be spinal cord ischemia during and after the procedure. Due to advances in anesthetic and surgical techniques, the incidence of intractable neurological complications has declined, but the rate of paraplegia or paraparesis is still within the range of 5-16%. Many methods have been devised to prevent this complication, such as 1) distal perfusion, 2) reimplantation of segmental arteries, 3) detection of the Adamkiewicz artery, 4) hypothermia, 5) cerebrospinal fluid drainage, 6) multisegmental aortic clamping, 7) motor-evoked potential monitoring, 8) epidural perfusion cooling, and 9) selective perfusion of the intercostal arteries and they can be utilized in combination.