PREVENTION OF SPINAL-CORD COMPLICATIONS IN AORTIC-SURGERY

Paraplegia or paraparesis after operations on the thoracic and abdomin al aorta is a devastating event, both for the patient and the surgeon. While its incidence varies from under 1% with operations at the top a nd bottom of the aorta, its occurrence in the midportion of the aorta, just above the diaphragm, even in the best of hands exceeds 10%. Over a decade ago, Crawford et al (J Vase Surg. 1986;3:389-404) introduced the use of inclusion and sequential clamping techniques for thoracoab dominal aneurysmectomy, lowering both morbidity and neurologic sequela e. Although these techniques have been widely adopted, newer ancillary adjuncts have been recommended by a number of investigators. This pap er summarizes the possible causes of paraplegia secondary to the vario us operations on the aorta and analyzes the status and value of the va rious ancillary techniques in its prevention. Am J Surg. 1998;176:92-1 01. (C) 1998 by Excerpta Medica, Inc.