Coverage of visible intercostal and lumbar segmental arteries can predict the volume of cerebrospinal fluid drainage in elective endovascular repair of descending thoracic and thoracoabdominal aortic disease: a pilot study

D’Oria, Mario; Chiarandini, Stefano; Pipitone, Marco; Calvagna, Cristiano; Ziani, Barbara

doi:10.1093/ejcts/ezy371

Cited by 8 publications

(11 citation statements)

References 29 publications

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“…A systematic review of the literature was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMAs) guidelines. 14 The PubMed/ MEDLINE, Scopus, Ovid, Cochrane, and EMBASE were queried for the following terms: Search terms were "(cerebrospinal fluid diversion OR CSF diversion OR lumbar drain OR subarachnoid drain OR spinal) AND (aortic aneurysm AND thoracic AND endovascular OR TEVAR)." The time period for article selection was from January 1, 2016, to December 17, 2018.…”

Section: Methodsmentioning

confidence: 99%

“…4,5 Indications for CSF drain placement included: all patients being treated with TEVAR (n ¼ 1), all patients being treated with TEVAR without specific contraindications (n ¼ 1), and patients determined by the authors to be high risk for SCI (n ¼ 6). 3,[11][12][13][14][15][16][17] Methods of risk stratification varied between studies but generally were based on the size of the aneurysm and/or involvement of branching or segmental arteries.…”

Section: Protocol and Indication For Csfdmentioning

confidence: 99%

“…Seven of 8 protocols for CSF drainage involved drainage of CSF to a target pressure, between 7 and 12 mm Hg. 3,11,[13][14][15][16][17] Three had limits of CSF volume drained, of 10 to 20 mL/h. 11,12,16 Three studies lowered the target CSF pressure if symptoms of SCI became evident.…”

Section: Protocol and Indication For Csfdmentioning

confidence: 99%

“…Since 2016, several studies have been published on the use of CSFD in TEVAR procedures. 2,3,[12][13][14][15][16][17] The aim of this systematic literature review is to provide an updated summary of the current literature regarding CSFD in endovascular aortic aneurysm repair. The primary objective of the review is to examine the utility of CSFD in adult patients who underwent endovascular aortic aneurysm repair in decreasing rates of SCI, and the secondary objective is to catalog the variations in CSFD protocols used within these studies.…”

Section: Introductionmentioning

confidence: 99%

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

Malloy

Raghavan

Elder

et al. 2019

Vasc Endovascular Surg

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Protocol and Indication For Csfdmentioning

confidence: 99%

Section: Protocol and Indication For Csfdmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Malloy

Raghavan

Elder

et al. 2019

Vasc Endovascular Surg

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“…3,4 The peril of SCI exists on a continuum, increasing as aortic coverage increases, but given the presence of an extensive collateral spinal network the number/percentage of segmental arteries covered, rather than the loss of any specific one, might be a more useful indicator of the risk for post-operative paraplegia. 5,6 We illustrate the application of F-BEVAR technology for the preservation of spinal artery flow during the endovascular repair of TAAA.…”

Section: Introductionmentioning

confidence: 99%

Use of Fenestrated Stent-Grafts for Preservation of Spinal Artery Flow During Endovascular Repair of Thoracoabdominal Aortic Disease

D’Oria

Wanhainen

Mani

2021

Annals of Vascular Surgery

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We illustrate the safety and feasibility of the application of fenestrated stent-grafts for the preservation of spinal artery flow during endovascular repair of thoracoabdominal aortic aneurysms (TAAA) in 2 patients deemed high-risk for spinal cord ischemia (SCI). In one case, an unstented fenestration was used in a 78-year-old male treated for distal stent-graft induced new entry tear. In the other case, a fenestration with a bridging stent-graft was used to revascularize a spinal artery in a 66-year-old female with Marfan disease and island patch aneurysm following open TAAA reconstruction. Both procedures were successful without any postoperative neurologic complication. The unstented fenestration led to a type III endoleak that required the relining of the aortic stent-graft 2 years later. The stented spinal fenestration was patent at a 5-year imaging follow-up.

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Postoperative Spinal Cord Ischemia and Stroke

Peng¹,

Tjaden²,

Charlton-Ouw³

2021

Vascular Complications of Surgery and Intervention

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Coverage of visible intercostal and lumbar segmental arteries can predict the volume of cerebrospinal fluid drainage in elective endovascular repair of descending thoracic and thoracoabdominal aortic disease: a pilot study

Cited by 8 publications

References 29 publications

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

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

Use of Fenestrated Stent-Grafts for Preservation of Spinal Artery Flow During Endovascular Repair of Thoracoabdominal Aortic Disease

Postoperative Spinal Cord Ischemia and Stroke

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