Prevention of Paraplegia Associated With Resection of Extensive Thoracic Aneurysms

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Abstract
• A review of the literature suggests that paraplegia associated with thoracic aortic surgery is preventable if intraoperative hypotension is eliminated, the distal aorta perfused adequately, and the intercostal arteries below T-8 level preserved. A surgical technique has been developed that leaves the posterior aortic wall, preserving the intercostal arteries below the level of T-8, and interspersing a diagonally tailored prosthesis with the aid of left atrial-to-femoral arterial bypass without heparinization. Seven patients with extensive aneurysms involving the entire descending thoracic aorta were operated on successfully by this technique without neurological complications. (Arch Surg 111:1186-1189, 1976)