A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta

Abstract

This article is concerned with the study of the effect of several variables, principally that of cerebrospinal fluid drainage, on the incidence of neurologic deficit in a prospective randomized series of patients with extensive aneurysms of the descending thoracic and abdominal aorta (thoracoabdominal type I and II). Forty-six patients had cerebrospinal fluid drainage, and 52 were controls, with a total of 98 available for study. Cerebrospinal fluid pressure was continuously monitored in the former group and pressure maintained less than or equal to 10 mm Hg in 20, less than or equal to 15 mm Hg in 20, and greater than 15 mm Hg in 6 patients during period of aortic clamping. The method of treatment including reattachment of intercostal and lumbar arteries (p = 0.2), temporary atriofemoral bypass during aortic occlusion (p = 0.3), and spinal fluid drainage (p = 0.8) were not statistically significant in reducing the incidence of neurologic deficits. Thus cerebrospinal fluid drainage as we used it, was not beneficial in preventing paraplegia. On appropriate statistical analysis we found that the only significant predictor of delayed deficits was postoperative hypotension (p = 0.006).

Outcome of open and endovascular repair in acute type B aortic dissection: a retrospective and observational study

“…The method of choice is conservative with aggressive medical therapy [1,2] using β- blockers, calcium-channel blockers and nitroglycerin to control heart rate and to maintain a systolic blood pressure less than 110 mmHg so lowering aortic wall tension. A surgical approach is reserved in all cases with complicated course such as persisted pain, rupture or impending rupture, visceral and/or leg ischemia with a mortality rate up to 50% [3] and high paraplegia rate [4], despite improved surgical techniques and perioperative care [5]. The recent review presented by the International Registry of Acute Aortic Dissection (IRAD) shows a surgical mortality of 27.8% and 62.5% in patients with malperfusion and rupture, respectively [6].…”