Surgery on thoracoabdominal aortic aneurysms

Intraoperative monitoring (IOM) of the central nervous system during surgical repair of or percutaneous stent placement in the aorta is an area of significant interest due to the substantial incidence of neurological injury with surgery. This is due to the ischemia, which results when the vascular supply to the brain and spinal cord is interrupted during the procedure. Of particular interest are procedures involving the thoracoabdominal aorta (TAA) where the reported incidence of paraplegia varies from 0.5% with aortic coarctation repairs where the procedure is short and the patient usually has well-developed collateral circulation to nearly 48% with emergency repairs of extensive thoracoabdominal degenerative lesions [1, 2]. It is clear that the risk of perioperative paralysis varies due to a substantial number of factors including the vessels effected by the surgery, the specific patient anatomy and disease, and the procedure.