A number of factors may increase or decrease the risk of spinal cord ischemia during and following vascular surgery on the abdominal aorta and iliac arteries.


Mechanisms for possible ischemic damage to the spinal cord:

(1) thromboemboli

(2) interruption of the arterial blood supply, with loss of collateral circulation

(3) poor perfusion



(1) atheroemboli from a "shaggy" aorta

(2) thrombosis


Interruption of the blood supply:

(1) failure to restore the pelvic arterial blood supply, especially in patients who have had a previous colectomy (associated with loss of collaterals from the inferior mesenteric artery)

(2) interruption of the arteria radicularis magna (artery of Adamkiewicz)


Poor perfusion:

(1) prolonged cross-clamping of the aorta

(2) rupture of an abdominal aortic aneurysm (with hypotension)

(3) hypotension


Factors reducing risk of ischemic injury:

(1) heparin therapy

(2) gentle handling of the arteries


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