SPINAL CORD AND PARAPLEGIA
One of the most dreadful, and devastating complication after repair of a descending or thoracoabdominal aortic aneurysm is paraplegia or paraparesis. This complication is the primary reason patients do not seek elective repair of these types of aortic aneurysms. Fortunately, the incidence of spinal cord injury secondary to theses types of aortic aneurysm repairs has decreased significantly over the past decade.
Paraplegia occurs because the aorta is one of the primary sources of blood for the spinal cord. There are small arteries (intercostal and lumbar) that come off the descending and abdominal aorta which provide blood to the spinal cord (look carefully at the anatomy section). During the operation or endovascular stent placement these arteries are either removed or covered thus, diminishing the blood supply to the spinal cord. However, there are other important arteries that provides blood to spinal cord.
Our laboratory studies and clinical experience has shown that the hypogastric and subclavian arteries are very important conduits that provide blood to the spinal cord. The "Collateral Network Concept" was first described by Dr. Randall B. Griepp and his research efforts are continuing at Hackensack University Medical Center. The concept describes the role of other important arteries to maintain normal spinal cord function such as the hypogastric, subclavian, internal mammary arteries, and small blood vessels within the muscles surrounding our spinal cord. Numerous studies from Dr. Griepp's laboratory have underscored the importance of this concept and preserving as many of these arteries during an operation to avoid injury to the spinal cord. The "Collateral Network Concept" has been adopted by other major aortic centers to improve their outcomes after descending and thoracoabdominal aortic aneurysm repair.
Paraplegia occurs because the aorta is one of the primary sources of blood for the spinal cord. There are small arteries (intercostal and lumbar) that come off the descending and abdominal aorta which provide blood to the spinal cord (look carefully at the anatomy section). During the operation or endovascular stent placement these arteries are either removed or covered thus, diminishing the blood supply to the spinal cord. However, there are other important arteries that provides blood to spinal cord.
Our laboratory studies and clinical experience has shown that the hypogastric and subclavian arteries are very important conduits that provide blood to the spinal cord. The "Collateral Network Concept" was first described by Dr. Randall B. Griepp and his research efforts are continuing at Hackensack University Medical Center. The concept describes the role of other important arteries to maintain normal spinal cord function such as the hypogastric, subclavian, internal mammary arteries, and small blood vessels within the muscles surrounding our spinal cord. Numerous studies from Dr. Griepp's laboratory have underscored the importance of this concept and preserving as many of these arteries during an operation to avoid injury to the spinal cord. The "Collateral Network Concept" has been adopted by other major aortic centers to improve their outcomes after descending and thoracoabdominal aortic aneurysm repair.
