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Spinal cord ischaemia after TEVAR — FRCA Final MCQ

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HardCardiothoracic and Vascular AnaesthesiaSpinal cord ischaemia after TEVARFRCA Final

A 69-year-old woman undergoes thoracic endovascular aortic repair for aneurysm. Four hours later she has new bilateral leg weakness and reduced pin-prick sensation below T10. Blood pressure is 92/50 mmHg and haemoglobin is unchanged. What is the most important next step?

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Correct answer: D — Raise mean arterial pressure and urgently assess for spinal cord rescue measures

New lower-limb neurological deficit after thoracic aortic repair suggests spinal cord ischaemia. Immediate rescue includes increasing spinal cord perfusion pressure by raising MAP, optimising oxygen delivery and considering CSF drainage according to local protocol. Lowering blood pressure can worsen cord perfusion. Time-critical vascular, anaesthetic and neurology input is required.

Reference: Vascular Anaesthesia Society aortic surgery guidance; RCoA Final FRCA Syllabus 2026