A systematic approach to paraplegia risk in the surgical treatment of thoracoabdominal aortic aneurysms based on effective strategies identified from the experimental literature is discussed. With this approach, collateral blood flow, rather than direct intercostal reimplantation, moderate hypothermia and endorphin receptor, is emphasized blockade. The result has been a 10-fold reduction in paraplegia risk in elective patients and a 5-fold reduction in acute patients. This reduction in paralysis risk has resulted in improved short- and long-term survival.
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