Pro & Con

horacic endovascular aortic repair (TEVAR) has become aneurysms were included and the extent of aortic coverage or Testablished as a less invasive option for the management of descending thoracic aortic diseases compared with conventional open surgical repair. TEVAR has reduced morbidity and mortality compared with open surgical repair, but still it is associated with a significant risk of spinal cord ischemia (SCI), which can lead to permanent paraplegia. The 2 major recognized medical interventions to prevent and treat spinal cord ischemia in patients undergoing TEVAR are arterial pressure augmentation and lumbar cerebrospinal fluid (CSF) drainage. Despite limited evidence from randomized controlled trials, the published clinical experience supports the effectiveness of CSF drainage as an adjunct for the treatment of patients with SCI and in prevention of permanent paraplegia as a consequence of TEVAR. Although there is little controversy regarding the use of lumbar CSF drainage for the treatment of SCI, considerable controversy exists as to whether preoperative insertion of a lumbar CSF drain is warranted as a prophylactic measure in patients undergoing TEVAR. Based on the existing clinical experience published in the medical literature, an argument can be made to support the routine use of prophylactic CSF drainage among patients undergoing TEVAR who are deemed preoperatively to be at high risk for SCI. The reported incidence of SCI after TEVAR ranges between 0% and 10.3%, with the average incidence being between 3% and 5%. Published clinical series suggested that the risk of SCI associated with TEVAR was less than that associated with open surgical repair; however, there was significant anatomic heterogeneity in these series. Indeed, most TEVAR procedures were performed for aortic pathology limited to the descending thoracic aorta. When patients with thoracoabdominal aortic