**5. Conclusions**

The feeding vessel network to the spinal cord is well known. Since SCI is a persisting clinical problem after open and endovascular aortic procedures, the scientific community has focused, once again, on the paraspinous and the intraspinal compartment. The aortic intervention-related steal phenomena can cause the hypoperfusion of the spine since large-volume muscles connected with the network and body movements can shift significant blood volumes shortly after TAAA surgery, which may be of importance during the first 24–72 h postoperatively. Even delayed rewarming and shivering might enhance the steal phenomena which contribute to SCI. Pre-conditioning with selective segmental artery occlusion reduces the blood supply to the CNS artificially, enhancing arteriogenesis. Both, arteries of the spinal cord as well as of the extremities are of skeletal muscle arterioles origin with transferable mechanisms according to arteriogenesis, involving signaling pathways like PI3K/AKT/eNOS, Erk1, the delta-like ligand, jagged (Jag)/NOTCH pathway, and the Midkine regulatory cytokine signaling. In the future, both arteriogenesis enhanced by the preconditioning of the blood supply of the central nervous system via selective segmental artery occlusion and the validation of biomarkers, e.g., NSE, GFAP, and S100B, might become additional cornerstones in the treatment of elective thoracic aortic repair, leading to a reduced risk of paraplegia or paraparesis.

**Funding:** This research received no external funding. **ConflictsofInterest:**Theauthorsdeclarenoconflictofinterest.
