Spinal cord injury after endovascular treatment for thoracoabdominal aneurysm or dissection
Selected in European Journal of Cardio-Thoracic Surgery by Rylski
Kato M, Motoki M, Isaji T, Suzuki T, Kawai Y, Ohkubo N
Eur J Cardiothorac Surg. 2015 Oct;48(4):571-7
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Spinal cord ischemia after repair of thoracoabdominal aortic aneurysm or dissection is a devastating complication. The authors report on spinal cord protection and neurological outcome in patients undergoing endovascular thoracoabdominal aortic repair.
- A total of 54 patients (mean age, 74 ± 9.6 years; 42 men) operated between 2007 and 2014 were included: 39 fenestrated/branched stent graft implantations, 10 hybrid procedures (bypass grafts to visceral arteries and straight stent graft implantation) and 5 with intentional coverage of the coeliac artery with a straight stent graft
- In all patients systemic blood pressure was maintained at ≥80 mmHg
- 74% had intraoperatively cerebrospinal fluid drainage
- Hospital mortality was of 6%
- No patient developed spinal cord ischemia in the perioperative period
- Two patients developed paraplegia as a consequence of shock caused by an aortic event
Spinal cord protection including spinal fluid drainage and avoiding low blood pressure peri- and postoperatively in patients undergoing endovascular repair in thoracoabdominal aortic segment reduces the risk of spinal cord ischemia effectively. Endovascular approach to thoracoabdominal aorta is a promising treatment option in appropriately selected patients.