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Intercostal Artery Reattachment Guided by Intraoperative Neurophysiologic Monitoring During Open Thoracoabdominal Aortic Repair: Basic Principles and Clinical Experience

  • Ubaldo Del CarroEmail author
  • Francesca Bianchi
  • Marco Cursi
  • Heike Caravati
Chapter

Abstract

Intraoperative neurophysiological monitoring (IOM) can promptly detect spinal cord ischemia (SCI) during thoracoabdominal aortic aneurysm (TAAA) repair. Early detection of SCI gives the team the opportunity to trigger interventions for maximizing spinal cord perfusion and potentially reverse spinal injury before ischemia evolves in infarction and permanent paraplegia. Literature data support the use of IOM as a strategy to manage hemodynamic optimization and to guide reimplantation of intercostal arteries, providing a level B of evidence. IOM can play a role in guiding a selective reattachment of the principal spinal cord feeder arteries, avoiding unnecessary reimplantation, and provide real-time information on the effectiveness of surgical interventions. IOM can be used to assess the several factors that may contribute to SCI in order to guide specific corrective measures, focusing efforts only on the necessary maneuvers and avoiding unnecessary and time-consuming procedures.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ubaldo Del Carro
    • 1
    Email author
  • Francesca Bianchi
    • 2
  • Marco Cursi
    • 2
  • Heike Caravati
    • 2
  1. 1.Department of Neurology and INSPEVita-Salute University, San Raffaele Scientific InstituteMilanItaly
  2. 2.Department of Neurology and INSPESan Raffaele Scientific InstituteMilanItaly

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