Mid-term follow-up of patients with permanent sequel due to spinal cord ischemia after advanced endovascular therapy for extensive aortic disease

Abstract

Study design: Observational study. Objectives: Thoraco-abdominal endovascular aortic aneurysm repair (TAEVAR) can be used to treat patients with extensive and complex aortic disease, however, at the risk of spinal cord ischemia (SCI). The aim of this follow-up study was to evaluate the life satisfaction in patients with SCI after TAEVAR. Setting: Among 83 patients undergoing TAEVAR between 2009 and 2012 at the Vascular Centre, Malmö, Sweden, 29 developed SCI in-hospital and at follow-up (median 26 months), eight had died and three had no complaints. Methods: Patients diagnosed with permanent (n = 10) and transient (n = 8) SCI were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were compared with reference samples. Results: Mid-term mortality in patients with permanent SCI (7/17) was higher than those with transient SCI (1/12) (P = 0.035). Ten patients had permanent T1-S5 SCI, two were classified as ASIA Impairment Scale (AIS) A, one as AIS B and seven as AIS D at hospital discharge. Patients diagnosed with transient SCI had residual neurological deficits in the legs (n = 8), urge incontinence (n = 3) and fecal leakage (n = 2) at follow-up. Patients with SCI had lower self-rated life satisfaction in terms of 'life as a whole', 'sexual life', 'somatic health' and 'psychological health' but better in the 'economy' domain. Conclusion: Assessment of life satisfaction at mid-term follow-up suggests that all patients with SCI in-hospital, whether permanent or transient, should have a multi-disciplinary follow-up regime. Most patients diagnosed with transient neurological deficits had an overlooked permanent, less severe, SCI.

Spinal cord injury after thoracic endovascular aortic aneurysm repair

“…These manifestations may be either transient (with partial or full recovery) or permanent ( with no regression). 5, 68 Mehmedagic et al 69 conducted mid-term follow-up on 29 patients with in-hospital transient neurological deficits and documented full recovery of these deficits before discharge. They reported a permanent, though less severe form of SCI in a subset of these patients, which was overlooked, reflecting the importance of transient paresis on patient long-term quality of life.…”

Life satisfaction in patients with and without spinal cord ischemia after advanced endovascular therapy for extensive aortic disease at mid-term follow-up

“…As reported earlier, 44 patients with no perioperative SCI were identified (4). At follow-up, 19 were deceased, and 35 patients with no symptoms of SCI remained.…”

“…A total of 83 patients at high risk for SCI underwent advanced endovascular therapy and cerebro-spinal fluid drain insertion for complex aortic disease at the Vascular Center, Malmö, Skåne University, Sweden, between 2009 and 2012. As reported previously, 29 patients had SCI peri-operatively (4). At follow-up, 8 patients were deceased; 3 patients were excluded due to no symptoms of SCI; and 18 patients with symptoms of SCI underwent an at-home interview (Fig.…”

“…Since spinal cord injuries result in a spectrum of deficits, such as paralysis, sensory impairments, neurogenic bowel and bladder dysfunction, sexual dysfunction and pain, it is important not to report only on whether ambulatory capacity is present. Investigators should at least determine the presence of urinary bladder dysfunction (2) and use established grading scales, such as the AIS, to assess neurological deficit, in order to make results interpretable and generalizable to other settings (4). Initial neurological assessment based on the AIS has been reported to be the best predictor of prognosis (12), but retrospective studies from vascular units are often hampered by the absence of consequent AIS grading in in-hospital patients (9,10,13).…”

“…Analysis of patient-reported outcome measures following advanced aortic repair is important to inform future counselling of patients in the planning stages of this procedure. A recent study assessed life satisfaction in patients with SCI after advanced endovascular therapy for extensive aortic disease at mid-term follow-up (4). The main criticism of this study was that these elderly patients with several comorbidities who had SCI after advanced endovascular therapy were compared with a large sample of healthy Swedes in the age range 18-64 years (5).…”