SPINAL-CORD COMPLICATIONS OF THORACOABDOMINAL ANEURYSM SURGERY

Background Although rare, paralysis secondary to spinal cord ischaemia after aortic aneurysm surgery is a devastating complication. Many pap ers have been published on this topic but without a clear consensus on the best way of minimizing the problem. Recent articles have included advanced pharmacological approaches and the literature has been revie wed in light of these. Methods Relevant papers were identified by an e xtensive text word search of the Medline database and a review of quot ed articles. Results Spinal cord complications are commoner after the repair of Crawford type II aneurysms than less extensive aneurysms. Th e presence of dissection, rupture and prolonged clamp times are associ ated with an increased incidence. About a quarter of all cord problems develop over 24 h after surgery and this may be due to a reperfusion type injury, although the exact mechanisms are by no means clear. Conc lusion A combination of rapid surgery, left heart bypass for the repai r of more extensive aneurysms, free spinal drainage and the avoidance of postoperative hypoxia and hypotension help to minimize spinal cord ischaemia. No pharmacological agent has yet been shown conclusively to improve outcome in the clinical setting.