Risk factors, outcomes, and clinical manifestations of spinal cord ischemia following thoracic endovascular aortic repair

Abstract

Spinal cord ischemia after TEVAR is an uncommon, but important complication. Preoperative renal insufficiency was identified as a risk factor for the development of SCI. Early detection and treatment of SCI with blood pressure augmentation alone or in combination with CSF drainage was effective in most patients, with the majority achieving complete, long-term neurologic recovery.

What should we do against delayed onset paraplegia following TEVAR?

“…Interestingly, in a prospective observation study, Maeda et al [14] showed that a greater percentage of patients with ischemic spinal cord injury following thoracic endovascular aneurysm repair (TEVAR) had a delayed paraplegia (66.7 %) than following traditional treatment (16.7 %). Similar results were also reported by Ullery et al [15]. Thus, it is expected that as TEVAR increases in the future, so will the incidence of delayed onset paraplegia.…”

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…Classification of DTAA according to the extension. 202 with a significant reduction in peri-operative mortality ( 216 Several reports confirm that specific anatomical conditions may represent potential risk factors for postoperative SCI. These include planned coverage of the thoracic aorta over more than 200 mm or involving the level T8-T12, previous abdominal aortic surgery with ligation of lumbar arteries, an occluded hypogastric artery, and, in the emergency setting the need for LSA coverage not amenable to revascularisation.…”

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

“…In 2011 Ullery BW et al [14] in 424 patients treated between 2002 and 2010 reported SCI rate of 2.8%.…”

“…Concluded " … of the prespecified factors investigated for association with SCI, only percentage of aortic coverage was significantly associated with the incidence of SCI; adjusted odds ratio per 10% increase in aorta covered = 1.78 [95% CI 1.81 -2.71], p = 0.007". In 2011 Ullery BW, Cheung AT, Fairman RM et al [14]. In a study of 424 patients un- In summary the factors that are clearly demonstrated within the scientific literature to be predictors for development of SCI are the extent of coverage of the aorta with a threshold of 205 mm absolute coverage or doubling for every 10% of aortic coverage.…”