Extent of Aortic Coverage and Incidence of Spinal Cord Ischemia After Thoracic Endovascular Aneurysm Repair

Feezor, Robert J.; Martin, Tomas D.; Hess, Philip J.; Daniels, Michael J.; Beaver, Thomas M.; Klodell, Charles T.; Lee, W. Anthony

doi:10.1016/j.athoracsur.2008.09.022

Cited by 180 publications

(135 citation statements)

References 10 publications

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“…In the latter half of the series, spinal drains were placed preoperatively if there was planned coverage of Ͼ150 mm of the thoracic aorta or if coverage extended to within 5 cm of the celiac artery. 5 For emergent cases, or in the setting of other physiological or anatomic conditions that precluded safe placement of a spinal drain, TEVAR was performed and a drain was placed postoperatively if the patient subsequently developed symptoms.…”

Section: Methodsmentioning

confidence: 99%

Late Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repairs

et al. 2011

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Background-In this study, we report the late outcomes of a large, decade-long single-center thoracic endovascular aortic repair experience. Methods and Results-A prospectively maintained registry and the electronic medical records of 400 consecutive thoracic endovascular aortic repair performed at a tertiary care center were reviewed. The distribution of pathologies treated included aneurysms (198, 49%), dissections (100, 25%), penetrating ulcers (54, 14%), traumatic transections (25, 6%), and other pathologies (23, 6%). Spinal drains were placed prophylactically in 127 cases (32%) of planned extended aortic coverage. There were no acute surgical conversions. Adjunctive surgical procedures were performed on 94 patients (24%). Subclavian revascularizations were performed selectively in only 15% of zone 0 to 2 deployments. The median length of stay was 5 days (limits, 1 and 79 days). Overall 30-day mortality was 6.5% (elective, 2.6%; urgent, 9.5%; and emergent, 20%). Permanent spinal cord ischemia occurred in 4.5% and stroke in 3%. Kaplan-Meier estimates of survival were 82%, 76%, 68%, and 60% and freedom from secondary intervention was 90%, 86%, 81%, and 78% at 6, 12, 24, and 36 months, respectively. Risk factors for mortality included stroke, urgent/emergent repair, age Ն80 years, general anesthesia, and dissection pathology. Conclusions-Thoracic endovascular aortic repair may be used to treat a variety of thoracic aortic pathologies with a very low risk of intraoperative conversion. Overall rates of mortality and neurological complications were relatively low but significantly increased in emergent repairs. There appeared to be a substantial number of late deaths, which may represent a combination of poor patient selection and treatment failures. (Circulation. 2011;123:2938-2945.)

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Section: Methodsmentioning

confidence: 99%

Late Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repairs

et al. 2011

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“…İşlemle ilişkili komplikasyonları nörolojik, iskemik ve vasküler giriş yolu ile ilgili olarak tanımlanır. [24][25][26] Vasküler giriş yolu ile ilgili komplikasyon için risk faktörleri torasik girişimde taşıyıcı sistemin 22-25 F'den daha büyük olması, küçük çaplı arter varlığı, kadın cinsiyet ve abdominal aort anevrizmalarına göre torasik anevrizmalar olarak sayılabilir. Nörolojik komplikasyonlar hem inme (stroke) hem spinal kord ile ilişkili sorunlardır.…”

Section: Discussionunclassified

Our endovascular therapy application for descending aortic pathology

Usta¹

2012

Turk Gogus Kalp Dama

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“…ROC curve analysis revealed 205mm of aortic length coverage as the threshold for increased risk of postoperative SCI (p = 0.001), with specificity and sensitivity of 95.2 and 80% respectively". Similarly Feezor RJ, Martin TD, Hess PJ et al [11] came to the following conclusion "patients with permanent SCI had a greater absolute (260.5 ± 40.9 vs 195.8 ± 81.6 mm, p = 0.002) and proportionate (88.8% ± 12.1% vs 67.6% ± 24.0%, p = 0.001) length of aortic coverage". Also Greenberg RK, Lu Q, Roselli EE et al [12] Found "No significant difference in the incidence of mortality or SCI was found between ER and SR techniques.…”

Section: What Are the Risk Factors For Spinal Cord Ischaemiamentioning

confidence: 99%

“…Two patients in the TEVAR group developed paraplegia and 7 developed paraparesis (5.6% SCI rate). Freezor et al [11] in Dec 2008 reported SCI rate of 10% in a retrospective series of 326 TEVAR treated patients. Greenberg RK et al [12] reported a comparison study of consecutive patients (n = 724)…”

Section: What Is the Incidence Of Spinal Cord Ischemiamentioning

confidence: 99%

Review of Thoracic Endovascular Aneurysm Repair (TEVAR), Spinal Cord Ischemia (SCI), Cerebrospinal Fluid (CSF) Drainage and Blood Pressure (BP) Augmentation

Englund¹

2017

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The object of this review is to examine the role of TEVAR in causing SCI. The anatomy and physiology of blood flow to the spinal cord is examined. The role of auto regulation of blood flow within the spinal cord is also examined. This review examines the reported results from the scientific literature of the effect of thoracic aortic aneurysm repair on spinal cord blood flow. In the light of these findings several conclusions can reasonably be reached. These conclusions are that the development of SCI can reasonably be predicted based on complexity and extent of the TEVAR procedure performed and BP augmentation and CSF drainage can significantly reduce the impact of SCI.

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Extent of Aortic Coverage and Incidence of Spinal Cord Ischemia After Thoracic Endovascular Aneurysm Repair

Cited by 180 publications

References 10 publications

Late Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repairs

Late Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repairs

Our endovascular therapy application for descending aortic pathology

Review of Thoracic Endovascular Aneurysm Repair (TEVAR), Spinal Cord Ischemia (SCI), Cerebrospinal Fluid (CSF) Drainage and Blood Pressure (BP) Augmentation

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