Spinal cord ischemia rates and prophylactic spinal drainage in patients treated with fenestrated/branched endovascular repair for thoracoabdominal aneurysms

Federica Locatelli; Petroula Nana; Thomas Le Houérou; Avit Guirimand; Marwan Nader; Antoine Gaudin; Côme Bosse; Dominique Fabre; Stéphan Haulon

doi:10.1016/j.jvs.2023.06.002

Spinal cord ischemia rates and prophylactic spinal drainage in patients treated with fenestrated/branched endovascular repair for thoracoabdominal aneurysms

J Vasc Surg. 2023 Oct;78(4):883-891.e1. doi: 10.1016/j.jvs.2023.06.002. Epub 2023 Jun 12.

Authors

Federica Locatelli¹, Petroula Nana¹, Thomas Le Houérou¹, Avit Guirimand¹, Marwan Nader¹, Antoine Gaudin¹, Côme Bosse¹, Dominique Fabre¹, Stéphan Haulon²

Affiliations

¹ Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris Saclay University, Paris, France.
² Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris Saclay University, Paris, France. Electronic address: haulon@hotmail.com.

PMID: 37315908
DOI: 10.1016/j.jvs.2023.06.002

Abstract

Objective: Spinal cord ischemia (SCI) is a devastating complication after thoracoabdominal aortic aneurysm (TAAA) repair. The benefit of prophylactic cerebrospinal fluid drainage (pCSFD) to prevent SCI is still under investigation. The aim of this study was to evaluate the SCI rate and the impact of pCSFD following complex endovascular repair (fenestrated or branched endovascular repair [F/BEVAR]) for type I to IV TAAA.

Methods: The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement was followed. A single-center retrospective study was conducted, including all consecutive patients, managed for TAAA type I to IV using F/BEVAR, between January 1, 2018, and November 1, 2022, for degenerative and post-dissection aneurysms. Patients with juxta- or pararenal aneurysms were excluded, as well as cases managed urgently for aortic rupture or acute dissection. After 2020, pCSFD in type I to III TAAAs was abandoned and replaced by therapeutic CSFD (tCSFD), performed only in patients presenting SCI. The primary outcome was the perioperative SCI rate for the entire cohort and the role of pCSFD for type I to III TAAAs.

Results: In total, 198 patients were included (mean age, 71.1±3.4 years; 81.8% males), including 50.5% with type I to III TAAA. The primary technical success was 94.9%. The perioperative mortality was 2.5%. and the major adverse cardiovascular event (MACE) rate was 10.6%; 4.5% presented SCI of any type (2.5% paraplegia). When comparing the SCI group with the remaining cohort, patients with SCI presented higher MACE (66.7% vs 7.9%; P < .001) rate and longer intensive care unit stay (3.5 vs 1 day; P = .002). Following type I to III repair, similar SCI, paraplegia, and paraplegia with no recovery rates were reported in the pCSFD and tCSFD groups (7.3% vs 5.1%; P = .66; 4.8% vs 3.3%; P = .72; and 2% vs 0%; P = .37).

Conclusions: The incidence of SCI after TAAA I to IV endovascular repair was low. SCI was associated with significantly increased MACE and intensive care unit stay. The prophylactic use of CSFD in type I to III TAAAs was not associated with lower SCI rates and may not be justified routinely.

Keywords: Aneurysm; Cerebrospinal fluid drainage; Mortality; Prevention; Spinal cord ischemia; Thoracoabdominal.

MeSH terms

Aged
Aneurysm* / surgery
Aortic Aneurysm, Thoracic* / diagnostic imaging
Aortic Aneurysm, Thoracic* / surgery
Aortic Aneurysm, Thoracoabdominal*
Blood Vessel Prosthesis / adverse effects
Blood Vessel Prosthesis Implantation* / adverse effects
Drainage / adverse effects
Endovascular Procedures* / adverse effects
Female
Humans
Male
Paraplegia / diagnosis
Paraplegia / etiology
Paraplegia / prevention & control
Retrospective Studies
Risk Factors
Spinal Cord Ischemia* / diagnosis
Spinal Cord Ischemia* / etiology
Spinal Cord Ischemia* / prevention & control
Treatment Outcome