Cerebrospinal Fluid Drainage During Endovascular Aortic Aneurysm Repair: A Systematic Review of the Literature and Treatment Recommendations

Abstract

Introduction: Spinal cord injury (SCI) is a known complication of aortic aneurysm repair. Previous reports indicate that cerebrospinal fluid drainage (CSFD) may reduce incidence of SCI during open aortic aneurysm repair but its utility in endovascular repair remains poorly understood. We performed a systematic review of the literature to examine the protocols and outcomes of CSFD in patients undergoing endovascular aortic aneurysm repair. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were utilized to conduct a systematic literature review. PubMed, Scopus, Ovid, Cochrane, and EMBASE were queried for articles published since 2016 using search terms “(cerebrospinal fluid diversion OR CSF diversion OR lumbar drain OR subarachnoid drain OR spinal) AND (aortic aneurysm AND thoracic AND endovascular OR TEVAR).” Ninety-two articles were identified and screened by 2 independent reviewers, and 23 studies met criteria for full-text review after initial screening. Results: A total of 8 studies met full inclusion criteria for final analysis. Six studies reported incidence of SCI in patients with CSFD and 2 compared SCI incidence between patients with and without CSFD. Protocols for drainage most commonly included draining to a target pressure intra- and postoperatively, between 8 and 12 mm Hg. Incidence of SCI ranged from 0% to 17% in patients with CSFD, and from 0% to 50% in those without CSFD. Rates of CSFD-related complications ranged from <1% to 28%. Conclusion: There may be a protective benefit of CSFD in preventing SCI, but there remains significant variation in drain placement protocols. Significant potential bias exists in the reviewed data. Higher quality studies on the role of CSFD in endovascular aortic aneurysm repair are needed.

Staging reinterventions for remodeling of residual aortic dissection: a single-center retrospective study

“…The reported incidence of symptomatic spinal cord ischemia following TEVAR ranges between 1% and 5% (31). Furthermore, patients considered at high risk are those who require TEVAR with extensive coverage of the thoracic aorta (32). In our approach, we position endografts to cover the entry tear and promote FL thrombosis for patients with TL compression below the renal artery and above the celiac trunk, as well as those with large or multiple entry tears.…”

False lumen–dependent segmental arteries are associated with spinal cord injury in frozen elephant trunk procedure for acute type I aortic dissection

“… 6 , 19 Extensive loss of SAs is a well-known predisposing event of SCI, which is also reflected in the results of the present study. 3 , 7 , 20 , 21 Among the 12 patients who developed SCI in the FL-dependency group, 5 occurred later than postoperative day 1, in which gradual formation of thrombosis in the FL during aortic remodeling might have been causing the process ( Figure 2 ). The mortality and SCI rate in our study were 17.1% and 10.3%, respectively, which seem a little greater than other studies.…”

Catéter de drenaje de líquido cefalorraquídeo: usos, técnica y complicaciones para el anestesiólogo

“…La incidencia de isquemia medular varió de 0% a 17% en pacientes con drenaje LCR y de 0% a 50% en aquellos sin drenaje LCR. Las tasas de complicaciones relacionadas con CDE oscilaron entre < 1% y 28% [9].…”