الفهرس 
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Abstract
Spinal cord ischemia (SCI) and paraplegia are among the most dreaded complications of Thoracic and Thoracoabdominal aortic endovascular repair. recently multimodality SCI prevention strategies are being used to decrease the incidence of paralysis. This study provided an overview of the current evidence on the effectiveness of peri-operative strategies to prevent spinal cord ischemia in endovascular thoracic and thoraco-abdominal aortic repair
The Aim of this study wass to determine medical and surgical predictors of paralysis post TEVAR and TEAVAR.
This study was Conducted retrospectively on patients underwent thoracic and thoracoabdominal aortic Aneurysm Endovascular Repair in Last 11 years (January 2012 till June 2022) in single center as regard incidence, personal history, medical and surgical risk factors, preventive strategies, reversibility of paralysis and associated mortality. Data was obtained from records; paralysis was diagnosed through clinical examination immediately after emergence from anesthesia and frequently post operatively in SICU or even word and after discharge in follow-up outpatient clinic visits.
Results on 137 patients underwent TEVAR and TEAVAR showed paralaysis in 15 patients with incidence of 10.9%, , 9 patients had complete reversal of their motor and sensory symptoms to the baseline preoperative status. 2 patients had partial reversal of their symptoms, and 4 patients had persistent symptoms. Duration of procedure is the most affecting risk factor on paralysis, patients with mean duration of 270 minutes had higher risk of paralysis.
Spinal cord injury is a devastating complication BUT till now it cant be fully prevented and some of its pathogenesis is not fully understood.
Neural cell regeneration and attenuating inflammatory response is the future direction in management of this complication.
CONCLUSION
P
aralysis is a DEVASTATING complication that occur with TEVAR, still it can’t be fully predicted, study showed that it is more linked to duration of procedure and to less extent to Lumbar drain insertion, urgency of procedure, number of stents inserted, extent of aortic coverage, HB level, usage of neuromonitoring and degenerative aneurysmal pathology. Normal Neuroimaging doesn’t exclude spinal cord injury as it was negative in 50% of paralysis cases. Reversibility of paralysis can’t be fully expected, in our center protocol for intervention include maintaining spinal cord perfusion through elevating mean blood pressure and maintaining CSF pressure below 10 mmhg through lumbar drain CSF drainage and administering naloxone. Full Reversibility occurred only in 73.3% of cases despite applying protocol of intervention.