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Ann Thorac Surg 2007;83:S865-S869
© 2007 The Society of Thoracic Surgeons

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Supplement

Spinal Cord Perfusion and Protection During Descending Thoracic and Thoracoabdominal Aortic Surgery: The Collateral Network Concept

Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York

^_* Address correspondence to Dr Griepp, Mt Sinai Medical Center, Cardiothoracic Surgery, 1 Gustave Levy Place, New York, NY 10029. (Email: ebgriepp{at}aol.com).

Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.

In the last two decades, as an increasing number of patients with descending thoracic and thoracoabdominal aneurysms are being diagnosed and treated, a more sophisticated understanding of spinal cord perfusion has become important in the attempt to minimize the frequency of spinal cord injury. The synthesis of information from laboratory studies and clinical experience has led to the collateral network concept, a framework for understanding spinal cord perfusion and thereby improving spinal cord protection during treatment of aneurysmal disease of the aorta distal to the left subclavian artery. Application of principles based on the collateral network concept has resulted in falling rates of spinal cord injury, which now approach 1% in descending thoracic aneurysm resection and less than 10% in extensive thoracoabdominal resections. These accomplishments suggest that, with further investigation, routine sacrifice of segmental aortic branches can be carried out in a way that will allow surgical and endovascular therapy of extensive distal aortic aneurysms without neurologic injury.

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