Spinal and visceral ischemia after endovascular aortic repair

With the evolution of endovascular therapy, there is a broader application of this technology for the treatment of aortic disease. The span of treatment is no longer limited to the descending thoracic aorta and the infrarenal abdominal aorta. The development of branched aortic endograft therapies has allowed stent graft treatment of more extensive thoracoabdominal aortic aneurysms and more complex aortic pathologies. With this rapidly expanding experience it is possible to better assess the complications that arise with this surgery. Two devastating complications that can occur with conventional aortic surgery are spinal cord and visceral ischemia. The incidence of these complications is low, and is often related to periods of visceral or cord malperfusion during periods of hypotension or aortic cross-clamping. Unfortunately, however, these complications continue to occur despite the use of endovascular technology. As the volume of endovascular aortic procedures increases, it is possible to more accurately assess the incidence of these dreaded complications. In addition, it appears that the pathophysiology associated with their development may occasionally differ from that observed in open surgery. Enhancing our understanding of spinal and visceral ischemia development during aortic endovascular surgery will allow us to more effectively prevent and treat their occurrences. This article will review our current understanding of the incidence, pathophysiology, preventive and treatment options for spinal cord and visceral ischemia associated with endograft surgery of the aorta.