{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T18:50:07Z","timestamp":1788202207610,"version":"build-2803163510"},"reference-count":27,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T00:00:00Z","timestamp":1731456000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Despite advances in complex endovascular aortic repair techniques, spinal cord ischemia (SCI) remains a devastating complication following endovascular thoracoabdominal aortic repairs. Novel strategies to preserve key intercostal\/lumbar arteries have been described. We report our early results of patients who underwent direct intercostal\/lumbar artery revascularization using endovascular incorporation of fenestrations\/branches or extra-anatomic approaches for fenestrated-branched endovascular aortic repairs (FBEVARs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A retrospective review of consecutive patients who underwent FBEVAR with intercostal\/lumbar artery revascularization from 2018 to 2022 was performed. Patient characteristics, intraoperative details, and outcomes including SCI and branch occlusions were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 317 patients who underwent FBEVAR during the study period, 12 patients were included. Aortic pathologies consisted of degenerative aneurysms (33%), postdissection aneurysms (33%), extensive penetrating aortic ulcers with intramural hematoma (25%), and visceral patch pseudoaneurysm (8%). Full thoracoabdominal coverage was required in 8 patients and supraceliac coverage &gt;10 cm was required in 4. Nine patients received endovascular incorporation, including directional branches (5\/9), unstented fenestrations (2\/9), and stented fenestration (2\/9). Three patients received extra-anatomic subcutaneous femoral-to-radicular artery bypass using a composite graft of polytetrafluoroethylene (PTFE) and venous conduit. Our institutional SCI prevention protocol, consisting of prophylactic cerebral spinal fluid drain (CSFD) for high-risk patients, hemodynamic augmentation, and oxygen supplementation, was followed. Prophylactic CSFD was placed in 9 patients. One patient had unsuccessful drain placement attempts. The other 2 patients had previous unsuccessful attempts at CSFD placement. Median number of target vessels for FBEVAR was 4 with fluoroscopy time 66\u00b131 minutes, contrast usage 109\u00b151 ml. There were no in-hospital mortalities. Tarlov grade II SCI (ASIA grade D) were seen in 2 patients (1 endovascular and 1 extra-anatomic bypass), which resolved before discharge. At mean follow-up of 472\u00b1447 days, 3 patients had thrombosed intercostal\/lumbar branches (1 extra-anatomic bypass and 2 endovascular branches) with no new SCI symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In patients at high risk for SCI undergoing FBEVAR, direct revascularization of an intercostal or lumbar artery is feasible using endovascular or extra-anatomic bypass approach. Further studies are planned to identify key contributing segmental arteries and optimization of revascularization strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>This study demonstrates the feasibility of Endovascular and extra-anatomic bypass to preserve segmental artery flow, aimed at reducing the risk of spinal cord ischemia during endovascular thoracoabdominal aortic repairs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028241294216","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T07:11:35Z","timestamp":1731481895000},"page":"1254-1262","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Multidisciplinary Approach to Direct Segmental Artery Revascularization to Prevent Spinal Cord Ischemia Associated With Endovascular Thoracoabdominal Aortic Repair"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7354-5042","authenticated-orcid":false,"given":"Anand V.","family":"Ganapathy","sequence":"first","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Hospital of USC, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9779-5564","authenticated-orcid":false,"given":"Alexander D.","family":"DiBartolomeo","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Hospital of USC, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Mack","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Keck Hospital of USC, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A.","family":"Magee","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Hospital of USC, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadiya","family":"Atai","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Keck Hospital of USC, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph N.","family":"Carey","sequence":"additional","affiliation":[{"name":"Division of Plastics Surgery, Department of Surgery, Keck Hospital of USC, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Russin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Keck Hospital of USC, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0715-4606","authenticated-orcid":false,"given":"Sukgu M.","family":"Han","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Hospital of USC, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,11,13]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/1538574413495461"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm12101629"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2014.12.034"},{"issue":"1","key":"e_1_3_2_5_2","first-page":"9","article-title":"Current results of total endovascular repair of thoracoabdominal aortic aneurysms","volume":"55","author":"Verzini F","year":"2014","unstructured":"Verzini F, Loschi D, De Rango P, et al Current results of total endovascular repair of thoracoabdominal aortic aneurysms. 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