Spinal Cord Ischemia Management Following Staged TEVAR and TAMBE

Authors

• Cecilia Li, Michigan State University College of Human Medicine Medical Student
• Eric Chen
• Nicholas Watson, Anesthesiology - Corewell Health West

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Thoracic endovascular aortic repair (TEVAR) and thoracoabdominal branch endoprosthesis (TAMBE) are increasingly utilized minimally invasive alternatives to open thoracoabdominal aortic repair, reducing perioperative morbidity and mortality in high-risk patients. However, spinal cord ischemia (SCI) remains a devastating complication, with risk increasing in patients undergoing extensive aortic coverage, staged procedures, prior thoracic stenting, or perioperative hypotension. Perioperative management is central to spinal cord protection through hemodynamic optimization, transfusion strategies, and implementation of SCI prevention and rescue protocols. We present a case of irreversible SCI following staged TEVAR and TAMBE, highlighting the cumulative effects of extensive aortic coverage and hemorrhagic shock despite aggressive intervention.

A 70-year-old female with hypertension, active tobacco use, and extensive prior vascular interventions presented for staged endovascular repair of a Crawford extent V thoracoabdominal aortic aneurysm with retrograde type B dissection. Four months earlier, she underwent hybrid thoracoabdominal repair including TEVAR, right iliofemoral bypass, and celiac artery stenting. Planned staged repair included left carotid-to-subclavian bypass, TEVAR with left subclavian coverage (3d later), and TAMBE (10d later). The first two stages were uneventful. Due to the extensive thoracic aortic coverage required, the patient was recognized as high risk for spinal cord ischemia.

This case demonstrates irreversible SCI following staged TEVAR and TAMBE in a patient with extensive prior thoracic stenting and perioperative hemorrhagic shock. Despite aggressive hemodynamic optimization, cerebrospinal fluid drainage, and full SCI rescue protocols, the patient developed permanent flaccid paralysis. The case exemplifies the cumulative risk of extensive aortic coverage and underscores both the critical role and limitations of strategies in spinal cord protection.

Recommended Citation

Li C, Chen E, Watson N. Spinal cord ischemia management following staged TEVAR and TAMBE. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2081