Central nervous ischemia after surgery of the thoracic aorta, functional characterization of the intraspinal collateral pathways in a large animal model

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Aortic diseases are usually treated by conventional surgical procedures or catheter-based techniques. During conventional prosthetic aortic replacement, as well as during placement of a stent-graft, perfusion pressure in spinal arteries drops. This can lead to paraplegia if sufficient collateral flow cannot be established. Depending on the type of procedure and on the extent of the specific aortic pathology, the incidence of paraplegia is as high as two to twenty percent. New treatment modalities of the aortic arch are accompanied by high rates of spinal ischemia. Detailed knowledge of the intraspinal collateral physiology is the basis of future risk stratification before an aortic procedure. In a surgical large animal model the physiological basis of spinal collateral flow, specifically of the intraspinal collateral compartment, will be studied. In a comparative study the basic role of the intraspinal arcades for a rapid recovery of spinal perfusion pressures will be shown. A group of animals with intact intraspinal collaterals as well as a group of animals with interrupted intraspinal collaterals will therefore undergo a simulated aortic procedure. Especially the exact role of the anterior radiculo-medullary arteries will be studied. The aim is to clarify which number of these arteries and what maximal distance between two of these arteries is required in order to safely perform a procedure on the thoracic aorta. This can be the basis of future preoperative risk stratification, which is still not possible today.