Lower extremity weakness after endovascular aneurysm repair with multibranched thoracoabdominal stent grafts

Sobel, Julia D.; Vartanian, Shant M.; Gasper, Warren J.; Hiramoto, Jade S.; Chuter, Timothy A.M.; Reilly, Linda M.

doi:10.1016/j.jvs.2014.10.013

Cited by 42 publications

(24 citation statements)

References 21 publications

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“…4,9,10,29 However, even with institution of all of these measures, permanent LEW still occurs in approximately 10% of patients undergoing complex endovascular thoracoabdominal aortic procedures, and the rates of transient LEW are even higher. 4,7,8 Hyperglycemia occurs in approximately 40% of patients after an ischemic stroke. 30,31 The presence of hyperglycemia is associated with infarct expansion, worse functional outcome, and increased mortality.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 99%

“…Risk factors for spinal cord ischemia (SCI) after endovascular repair of thoracic aortic diseases include prior history of aneurysm repair, increased length of aortic coverage, hypotension, coverage of important collateral vessels (subclavian and internal iliac arteries), and a "shaggy" aorta prone to embolization. [1][2][3][4][5][6][7][8] Multimodal strategies to improve spinal cord perfusion have decreased the paraparesis and paraplegia rates. 4,9,10 Despite these measures, paraplegia still occurs in approximately 5% to 10% of patients undergoing endovascular TAAA repair.…”

mentioning

confidence: 99%

“…4,9,10 Despite these measures, paraplegia still occurs in approximately 5% to 10% of patients undergoing endovascular TAAA repair. 4,7,8 Hyperglycemia is associated with worsened clinical outcomes in the setting of acute ischemic stroke, severe head injury, and subarachnoid hemorrhage. [11][12][13][14][15][16][17] It is not clear whether hyperglycemia is a marker for increased severity of neurologic damage or whether it contributes to secondary injury.…”

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confidence: 99%

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Lower extremity weakness is associated with elevated blood and cerebrospinal fluid glucose levels following multibranched endovascular aortic aneurysm repair

Hiramoto

Fernandez

Gasper

et al. 2017

Journal of Vascular Surgery

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Objective: Hyperglycemia is associated with worsened clinical outcomes after central nervous system injury. The purpose of this study was to examine the association between lower extremity weakness (LEW) and the glucose levels of blood and cerebrospinal fluid (CSF) in patients undergoing multibranched endovascular aneurysm repair (MBEVAR) of thoracoabdominal and pararenal aortic aneurysms. Methods: Blood and CSF samples were collected preoperatively, immediately after aneurysm repair, and on postoperative day 1 in 21 patients undergoing MBEVAR. Data on demographics, operative repair, complications, and outcomes were collected prospectively. Results: There were 21 patients who underwent successful MBEVAR. Two patients had pre-existing paraplegia from prior open aortic surgery and were excluded from the current analysis. The mean age was 73 6 8 years, and 15 of 19 (79%) were men. In the postoperative period, 7 of 19 (37%) patients developed LEW. This was temporary in 5 of 19 (26%) patients and permanent in 2 of 19 (11%) patients. The LEW group was older than the non-LEW group (77 6 6 vs 70 6 9 years, respectively; P ¼ .10), had a lower preoperative glomerular filtration rate (58.6 6 18.5 vs 71.4 6 23.5 mL/min per 1.73 m 2 ; P ¼ .24), and was more likely to be taking a statin (100% vs 67%, respectively; P ¼ .13), but these did not reach statistical significance. There was no significant difference in the prevalence of diabetes mellitus, hypertension, coronary artery disease, lung disease, or peripheral artery disease between the LEW and non-LEW groups. There was also no difference in operative time, blood loss, contrast material volume, or fluoroscopy times between the two groups. Preoperative blood and CSF glucose levels were similar in those with and without LEW. During the postoperative period, glucose values in the blood and CSF were significantly higher in those patients who developed LEW compared with those who did not develop LEW. In all patients with LEW, the elevation in the blood or CSF glucose level preceded the development of LEW. In a multivariable logistic regression model, CSF glucose concentration on postoperative day 1 was significantly and independently associated with the development of LEW (odds ratio, 2.30 [1.03-5.14] per 10 mg/dL increase in CSF glucose; P ¼ .04). Conclusions: Elevated blood glucose and CSF glucose levels are associated with postoperative LEW in patients undergoing MBEVAR. The protective effect of euglycemia deserves further study in patients at risk for spinal cord ischemia.

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Section: Journal Of Vascular Surgerymentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Lower extremity weakness is associated with elevated blood and cerebrospinal fluid glucose levels following multibranched endovascular aortic aneurysm repair

Hiramoto

Fernandez

Gasper

et al. 2017

Journal of Vascular Surgery

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“…[14][15][16][17][18][19] Despite improvements in the technology, this approach is limited by the development of SCI, branch-related endoleaks, and branch occlusion. [20][21][22][23] Longer-term outcomes are excellent but highlight the need for a better understanding of the effects of endograft treatment of extensive TAAA. The aim of this current study was to evaluate outcomes for patients with extensive TAAA (type II and III) treated with F/B-EVAR.…”

mentioning

confidence: 99%

Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysms

Eagleton

Follansbee

Wolski

et al. 2016

Journal of Vascular Surgery

254

169

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F/B-EVAR is a robust treatment option for patients at increased risk for conventional repair of extensive TAAAs. Technical success and branch patency are excellent, but some patients will require reintervention for branch-related endoleak. Aneurysm extent portends a higher risk of perioperative and long-term morbidity and mortality. Additional efforts are needed to improve outcomes and understand the utility of this treatment option in the general TAAA population.

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“…However, branches that do not align with the fenestrations can cause branch occlusion and prolong occlusion time of the lower limbs, as well as type III endoleaks because of existence of many connections between the fenestrations of stent graft and branch stents with no overlaps. 19,20)…”

Section: Endovascular Treatment Using Stent Graft For Thoracoabdominamentioning

confidence: 99%

Midterm Results of Endovascular Treatment for the Patients with Thoracoabdominal Aortic Aneurysms

Kanaoka

Ohki

2019

Annals of Vascular Diseases

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Treatment of thoracoabdominal aortic aneurysm (TAAA) remains a challenging pathology. Technologies and innovations of endovascular treatment, in particular the evolution of fenestrated and branched stent graft for complex aortic pathologies such as TAAA have provided excellent short-term results. However, the mid-term and long-term results of endovascular treatment for TAAA including endoleaks and branch patency are still unclear. This article provides an overview of available devices and results of endovascular treatment for TAAAs. (This is a translation of Jpn J Vasc Surg 2019; 28: 67–74.)

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Lower extremity weakness after endovascular aneurysm repair with multibranched thoracoabdominal stent grafts

Abstract: Most episodes of LEW after multibranched endovascular aneurysm repair are transient and do not occur in the operating room. Adjunctive strategies to maintain spinal perfusion, including cerebrospinal fluid drainage and permissive hypertension, may help prevent permanent LEW.

Cited by 42 publications

References 21 publications

Lower extremity weakness is associated with elevated blood and cerebrospinal fluid glucose levels following multibranched endovascular aortic aneurysm repair

Lower extremity weakness is associated with elevated blood and cerebrospinal fluid glucose levels following multibranched endovascular aortic aneurysm repair

Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysms

Midterm Results of Endovascular Treatment for the Patients with Thoracoabdominal Aortic Aneurysms

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