Spinal Cord Ischaemia After TEVAR — EECC MCQ

Correct answer: B — Spinal cord ischaemia (SCI) from coverage of intercostal arteries supplying the artery of Adamkiewicz (the major segmental feeder to the anterior spinal artery) — prevention includes CSF drainage, avoiding hypotension, staged procedures, and preserving subclavian artery flow

Spinal cord ischaemia is the most feared complication of thoracic aortic repair (both TEVAR and open), occurring in 2-8% of cases. The spinal cord is supplied by the anterior spinal artery, which receives segmental feeders from intercostal/lumbar arteries — the artery of Adamkiewicz (typically arising T9-T12) is the dominant feeder. TEVAR coverage of the aorta (particularly long segment coverage involving multiple intercostal arteries) can interrupt this supply. Prevention strategies: (1) CSF drainage (lumbar drain — reduces spinal cord perfusion pressure by lowering CSF pressure); (2) maintain MAP >80-90 mmHg; (3) staged procedures (covering shorter segments at intervals to allow collateral development); (4) avoid occluding the left subclavian artery (contributes to vertebral artery and therefore posterior spinal circulation — revascularise if covered); (5) minimise coverage length. The 2024 ESC Aortic Disease Guidelines recommend these strategies for all extensive thoracic coverage.

Reference: ESC (2024): Aortic Disease Guidelines