Paraplegia, one of the most significant postoperative complications for patients undergoing thoracic and thoracoabdominal aortic aneurysm surgery, results from too little perfusion to the spinal nerves.1,2  Time with an aortic cross-clamp in place, hypothermia, and reperfusion injury are a few of the contributing factors. Wan et al reported that the risk of paraplegia with reconstructive surgery ranges between 5% and 40%, and potential improvements are achieved with distal aortic perfusion techniques and cerebrospinal fluid (CSF) drainage. Safi et al proposed a 16% to 31% risk of paraplegia with high-risk thoracoabdominal aortic aneurysm repair. This risk can increase to 50% with a cross-clamp in place longer than 45 minutes. The risk with thoracic endovascular repair is much lower at 1.5%, although that risk increases to 2.88% when protocols are not used, and to 5.6% when protocols are applied...

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