Staged approach for spinal cord protection in hybrid thoracoabdominal aortic aneurysm repair.

At present, there are three available options for surgical thoracoabdominal aortic aneurysm (TAAA) repair: conventional open surgery, total endovascular repair, and a hybrid approach, involving conventional surgical and endovascular techniques. Each modality has a different risk/benefit profile, requiring careful patient selection. Spinal cord injury (SCI) due to compromised blood supply following extensive segmental artery (SA) sacrifice is a daunting complication observed with all three approaches. A thorough understanding of the response of the spinal cord vasculature to SA sacrifice is essential to minimize the incidence of SCI after open or endovascular repair of TAAA. For over a decade, perioperative spinal cord protection during TAAA repair has been investigated in Dr. Griepp’s laboratory at The Mount Sinai Hospital in New York. Clinical and experimental work have provided insight into the anatomy of the extensive vascular network surrounding the spinal cord, and its dynamic response to SA sacrifice. This new understanding of spinal cord perfusion has been termed the Collateral Network Concept (CNC) (1).