STRATEGIES OF SPINAL CORD PROTECTION DURING AORTIC SURGERIES

Abstract

The abdominal aorta is defined as aneurysmal when a localized dilation is identified, and the diameter of that region is increased more than 50% relative to normal aortic diameter. For most individuals, an aortic diameter greater than 3.0 cm is generally considered aneurysmal. Endovascular repair of abdominal aortic aneurysm (EVAR) represents a widely available alternative to open surgical repair. The preprocedural evaluation of patients undergoing endovascular repair requires medical risk assessment and a careful quantitative and qualitative evaluation of aortoiliac anatomy to determine suitability for repair . Most endovascular aortic repair (EVAR) cases are performed using local anesthesia with monitored anesthesia care (MAC) or neuraxial regional anesthesia. General anesthesia may be preferable in selected patients due to level of anxiety or inability to cooperate, remain motionless, or lie supine (eg, severe heart failure or back pain). Intraoperative monitoring includes electrocardiography and direct intra-arterial blood pressure monitoring. Blood pressure is controlled throughout the procedure to minimize risk of myocardial and renal ischemia.