Editor's choice--Temporary aneurysm sac perfusion as an adjunct for prevention of spinal cord ischemia after branched endovascular repair of thoracoabdominal aneurysms

P M Kasprzak; K Gallis; B Cucuruz; K Pfister; M Janotta; R Kopp

doi:10.1016/j.ejvs.2014.05.020

Editor's choice--Temporary aneurysm sac perfusion as an adjunct for prevention of spinal cord ischemia after branched endovascular repair of thoracoabdominal aneurysms

Eur J Vasc Endovasc Surg. 2014 Sep;48(3):258-65. doi: 10.1016/j.ejvs.2014.05.020. Epub 2014 Jul 2.

Authors

P M Kasprzak¹, K Gallis², B Cucuruz², K Pfister², M Janotta², R Kopp²

Affiliations

¹ Department of Surgery, Vascular and Endovascular Surgery, University Hospital, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. Electronic address: gefaess.chirurgie.@ukr.de.
² Department of Surgery, Vascular and Endovascular Surgery, University Hospital, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.

PMID: 24996930
DOI: 10.1016/j.ejvs.2014.05.020

Abstract

Objective: To report experience with the concept of temporary aneurysm sac perfusion (TASP) and second stage side branch completion to prevent severe spinal cord ischemia (SCI) after branched endovascular aortic repair (bEVAR) for thoracoabdominal aortic aneurysm (TAAA).

Methods: Patients were treated for TAAA with bEVAR between January 2009 and September 2012. TASP was performed by non-completion of side branches to one of the reno-visceral arteries, distal aortic or iliac extensions with secondary side branch completion. Primary endpoints of the study were overall technical success, side branch patency, perioperative mortality, and the rate of severe SCI.

Results: Eighty-three patients were treated for TAAA with branched aortic stent grafts with (n = 40) or without (n = 43) TASP. Overall technical success, including aneurysm exclusion, absence of persistent type I or III endoleak, TASP side branch patency, and secondary side branch completion was 35/40 (88%). Secondary TASP side branch completion was performed after a median of 48 days (range 1-370 days). The rate of early re-interventions for reno-visceral side branch complications was 8/283 (3%) and 6/83 (7%) for perioperative mortality, with three patients in both groups. Severe SCI or paraplegia was observed in 11/83 (13%) of the patients and reduced in the TASP group (2/40) compared with the non-TASP group (9/43; p = .03), especially in Crawford I-III aneurysms (1/29 vs. 7/24; p = .01). However, one TASP patient died 4 months after bEVAR during the TASP interval from suspected aorto-bronchial fistula.

Conclusion: The concept of TASP after bEVAR for TAAA is feasible and seems to reduce the risk of SCI. Early side TASP branch completion within 4 weeks is recommended to reduce the risk of rupture, although, according to the individual clinical presentation, a longer TASP interval might improve neurological rehabilitation from SCI.

Keywords: Aortic stent graft; Branched endovascular aortic repair; Spinal cord ischemia; TASP; Temporary aneurysm sac perfusion; Thoracoabdominal aneurysm.

MeSH terms

Aged
Aortic Aneurysm, Thoracic / mortality
Aortic Aneurysm, Thoracic / surgery*
Blood Vessel Prosthesis Implantation / methods*
Blood Vessel Prosthesis Implantation / mortality
Blood Vessel Prosthesis*
Diagnostic Imaging
Endovascular Procedures / methods*
Endovascular Procedures / mortality
Feasibility Studies
Female
Humans
Male
Postoperative Complications / diagnosis
Postoperative Complications / prevention & control*
Spinal Cord / blood supply*
Spinal Cord Ischemia / diagnosis
Spinal Cord Ischemia / mortality
Spinal Cord Ischemia / prevention & control*
Stents*
Treatment Outcome
Vascular Patency