Abstract: AIM: To evaluate the efficacy of selective intercostal arterial perfusion in the protection of spinal cord during descending aortic surgery. METHODS: A comparative study was conducted among 10 patients undergoing descending aorta replacement without selective intercostal arterial perfusion and six patients undergoing descending aorta replacement with selective intercostal arterial perfusion. We performed selective intercostal arterial perfusion from the T1 intercostal artery to the T10-11 intercostal artery through a Dacron graft branch to protect the spinal cord from ischemia. The rate of paraplegia was compared between groups after surgery and during follow-up ranging from 4 to 14 months. RESULTS: Mean ischemic duration of non-perfusion group was (28.9±3.6)min (range: 24-36 min). Postoperative paraplegia occurred in one patient after surgery. Mean ischemic duration of selective perfusion group was (25.0±1.7)min (23-27 min) and no postoperative paraplegia occurred post-operatively or during follow-up. CONCLUSION: Selective intercostal arterial perfusion reduces ischemic time and severity of spinal cord injury. This method offers good protection for spinal cord and facilitates surgery.