Spinal cord protection and related complications in endovascular management of B dissection: LSA revascularization and CSF drainage.

The endovascular repair of thoracic aorta (TEVAR) has significantly decreased the overall incidence of neurologic complications when compared with open surgery. Nevertheless, the risk of paraplegia remains an important concern, with rates ranging from 2% up to 8% (1). Risk factors for spinal cord ischemia following TEVAR include prior abdominal aortic aneurysm (AAA) repair, prolonged hypotension, severe atherosclerosis of the thoracic aorta, occlusion of the left subclavian artery (LSA) or hypogastric arteries, and more extensive coverage of the thoracic aorta by the graft (1). Different strategies have been developed over time to protect the spinal cord from ischemic insult during thoracic aortic repair (2) (see Table 1). LSA revascularization and cerebral spinal fluid (CSF) drainage are the two more invasive preventive maneuvers applied in TEVAR for treating type B dissection which may be associated with relevant pitfalls.