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

Abstract

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.

Neuron-Derived Exosome Proteins May Contribute to Progression From Repetitive Mild Traumatic Brain Injuries to Chronic Traumatic Encephalopathy

“…In the first example, ten patients undergoing multi-branched endovascular repair of aortic aneurysms were studied pre-operatively, immediately postoperatively and the day after surgery. This form of surgery is often associated with ischemic hyperglycemic spinal damage and prolonged lower extremity weakness despite application of intra-operative counter-measures (Hiramoto et al, 2017). The mean level of NDEs fell significantly after surgery and returned the following day to that observed pre-operatively.…”

A Systematic Review of the Use of Biochemical Markers in the Assessment of Spinal Cord Ischemia in Thoracoabdominal Aortic Aneurysm Repair

“…There appears to be some promise in NFL and GFAp as SCIspecific biomarkers, with evidence consistently demonstrating significant elevations in both proteins for patients who had SCI. The GFAp is an insoluble structural protein of fibrillary 31 NFL, Tau CSF After induction of anesthesia, and at 1, 3, 6, 12, 24, and 48 hours after endovascular stent graft in position 14 Harimoto et al 33 Glucose CSF, Serum Collected preoperatively, immediately after aneurysm repair, and on postoperative day 1…”

Arteriogenesis of the Spinal Cord—The Network Challenge

“…There is a clear preference for TEVAR in all major industrial countries, because of the reduced rates of paraplegia [9,10]. However, even pararenal endovascular aortic repair holds the risk of spinal cord ischemia, especially when the hypogastric artery becomes occluded during the procedure [11,12]. More specifically, there are numerous risk factors that influence the patient outcome, such as, e.g., the extended length of covered aortic segments, the placement of stent grafts between TH9-Th12, the occlusion of the left subclavian artery, perioperative hypotension, and long total procedure time [8].…”