Spinal cord ischemia in TEVAR – Cardiology MCQ – Answer

Correct answer: d) All of the above

Spinal cord ischemia manifesting as paraplegia is one of the important complications of TEVAR (thoracic endovascular repair of aortic aneurysm). Avoiding blockage of left subclavian which gives branches which eventually supply the spinal cord is a preventive option in elective setting. In cases in which left subclavian needs to over stented,  a hybrid procedure with a surgical graft to the vessel likely to be blocked being placed before TEVAR is an option. Pre procedure drainage of CSF (cerebrospinal fluid) can be useful as it has been proven useful in aortic surgery for protection of spinal cord. CSF drainage is an immediate option for reversal of paraplegia if it does occur unfortunately. Other option is to raise the blood pressure with mean around 90 mm Hg. Episodes of hypotension should be prevented as far as possible to prevent spinal cord ischemia.