Epidural Corticosteroids, Lumbar Spinal Drainage, and Selective Hemodynamic Control for the Prevention of Spinal Cord Ischemia in Thoracoabdominal Endovascular Aortic Repair: A New Clinical Protocol

Pasqualucci, Alberto; Alsibaie, Ayman; Vaidyan, Kurian Palavilayil Thomas; Paladini, Antonella; Nadhari, Mansour Yousef; Gori, Fabio; Greiss, H; Properzi, M.; Ani, Osama Sami Maki Al; Godwin, Aruna; Syedkazmi, Altaf Hussein; Elhanf, Osama Ahmed; Varrassi, Giustino

doi:10.1007/s12325-019-01146-7

Cited by 12 publications

(5 citation statements)

References 61 publications

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“…Bobadilla et al, in a study including 94 patients submitted to TEVAR mainly for the treatment of aneurysms or dissections, reported an incidence of SCI as low as 1.1% and attributed these results to the implementation of a proactive spinal cord protective protocol, which included the administration of methylprednisolone 30 mg/kg [86] . Similarly, Acher et al observed a very low incidence of SCI (0.65%) in 155 patients submitted to TEVAR, encouraging the simultaneous use of numerous spinal cord protective measurements, including the intraoperative administration of methylprednisolone 30 mg/kg [93] . Pasqualucci et al, in a study including 50 patients submitted to endovascular repair of TAAA, reported the use of high doses of epidural steroids just before anesthesia induction, and observed 5 cases of temporary neurological deficit, all of them completely reversed up to the fifth postoperative day [94] .…”

Section: Hemodynamic Management For Spinal Cord Protection During Taa...mentioning

confidence: 91%

Strategies for prevention of spinal cord ischemia in the management of thoracic and thoracoabdominal aneurysms

Gomes,

Farber,

Parodi

2023

Vessel Plus

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Spinal cord ischemia (SCI) is undoubtedly the most devastating adverse event that occurs after either a thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA) repair. While open surgery techniques and minimally invasive endovascular options are now available for treating complex anatomy aortic aneurysms, spinal cord ischemia still occurs to a greater extent than desirable. Multiple risk factors have been associated with this adverse event, such as advanced age, perioperative hypotension, extent of the repair, and ligation of multiple intercostal and lumbar arteries during the surgical repair. The present literature review aims to analyze the contributing risk factors for SCI in the context of aortic surgery, explore the most relevant strategies for preventing postoperative SCI, and discuss the current management strategy when this complication occurs.

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Section: Hemodynamic Management For Spinal Cord Protection During Taa...mentioning

confidence: 91%

Strategies for prevention of spinal cord ischemia in the management of thoracic and thoracoabdominal aneurysms

Gomes,

Farber,

Parodi

2023

Vessel Plus

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“…Another protocol designed by Pasqualucci et al describes the use of epidural steroids in addition to CSF drainage and strict hemodynamic control. Their protocol, which was followed in 50 patients undergoing TEVAR for TAAA, resulted in no patients with SCI 5 days after surgery [21]. An additional protocol which was designed by Bobadilla et al used similar techniques as Pasqualucci which involved CSF drainage, steroid administration, and maintaining MAP goals.…”

Section: Andandmentioning

confidence: 99%

Spinal drain for aortic aneurysm repairs: tool or toy?

Bastug¹,

Worrall²,

Webb³

et al. 2022

Current Opinion in Anaesthesiology

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Purpose of reviewSpinal cord injury (SCI) is one of the biggest complications in open and endovascular aortic repairs. Historically, cerebrospinal fluid drains (CSFD) have been one of the most effective modalities in reducing SCI and one of the most studied. CSFD placement also carries its’ own set of procedural risks. This editorial intends to evaluate recent literature to determine whether CSFDs remain a valuable tool in aortic repair.Recent findingsAs the surgical management of thoracic aortic aneurysms has evolved, there has been an increasing number of endovascular repairs. Current recommendations emphasize prophylactic CSFD placement in endovascular repair cases deemed ‘high risk.’ However, several meta-analyses differ on whether prophylactic CSFD placement reduced the risk of SCI. The incidence of SCI decreased between 2014 and 2018, despite a similar rate of prophylactic CSFD placement suggesting other techniques are being performed and may be effective in spinal cord protection as well.SummaryThere has been conflicting data on whether CSFDs have a role in reducing the risk of SCI in endovascular aortic repair. Some studies suggest that there is no benefit to placement while others suggest that routine prophylactic drains should be placed for all endovascular cases. Despite this, efforts have been made to selectively place CSFDs in those patients deemed at ‘high risk’ for SCI. CSFDs also remain a part of rescue treatment for postoperative SCI. This suggests that CSFDs continue to be a valuable tool that we need to better comprehend. Future research is necessary to better understand how patient risk factors can be balanced with perioperative management to help identify patients who may benefit from CSFD placement.

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“…4,5 Volume resuscitation with an optimized hemoglobin level and blood pressure, the use of epidural corticosteroids, and carotid-subclavian bypass may be beneficial to protect against neurological events. 5,13–17 In terms of left subclavian artery (LSA) coverage, although LSA revascularization synchronous with endovascular repair is associated with a decreased SCI rate, this maneuver was not found to significantly reduce total neurological complications or mortality. 16,17 Endovascular LSA revascularization may also be an option in TEVAR.…”

Section: Selected Controversial Topicsmentioning

confidence: 99%

Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

Σπανός

Nana

Behrendt³

et al. 2021

J Endovasc Ther

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Cardiovascular societies have developed recommendations regarding the management of thoracic aortic diseases. While improvements in treatment have been observed during the past decade in regard to patient selection, thoracic endovascular aortic repair (TEVAR) and associated techniques, and high-volume centralization, the broad expansion of TEVAR has raised considerations about its indications, appropriateness, limitations, and application. The aim of this systematic review was to assess the similarities and differences among current cardiovascular societies’ guidelines for the management of thoracic aortic diseases. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from January 2009 to May 2020. The initial search identified 990 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from cardiovascular societies published between 2010 and 2020. Selected controversial topics were analyzed, including diagnosis, imaging, spinal cord ischemia prevention, and management of the most important thoracic aortic pathologies. The analysis included data concerning the therapeutic approach in acute and chronic type B aortic dissection, penetrating aortic ulcer, intramural hematoma, thoracic aortic aneurysm, and traumatic aortic injury, as well a discussion of inflammatory aneurysms, aortitis, and genetic syndromes. The review presents consistent and controversial recommendations, as well as “gray zone” issues that need further investigation. There was significant overlap and agreement among the 5 societies regarding the management of thoracic aortic diseases. Especially in dissection and aneurysm management, TEVAR has established its role as the treatment of choice. However, robust evidence is still needed in many aspects of the management of thoracic aortic pathologies.

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Epidural Corticosteroids, Lumbar Spinal Drainage, and Selective Hemodynamic Control for the Prevention of Spinal Cord Ischemia in Thoracoabdominal Endovascular Aortic Repair: A New Clinical Protocol

Cited by 12 publications

References 61 publications

Strategies for prevention of spinal cord ischemia in the management of thoracic and thoracoabdominal aneurysms

Strategies for prevention of spinal cord ischemia in the management of thoracic and thoracoabdominal aneurysms

Spinal drain for aortic aneurysm repairs: tool or toy?

Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

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