Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta☆

Gottardi, Roman; Dumfarth, Julia; Holfeld, Johannes; Schoder, Maria; Funovics, Martin; Laufer, Guenther; Grimm, Michael; Czerny, Martin

doi:10.1016/j.ejcts.2009.12.007

Cited by 24 publications

(19 citation statements)

References 19 publications

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“…Additionally, previous reports have suggested that neurologic recovery with delayed paraplegia compared to immediate paraplegia has a more favorable outcome 7, 9, 11–13 but small sample sizes make it difficult to draw definitive conclusions about the natural history of SCI after TEVAR. Moreover, few reports have focused on the long-term functional outcome of patients with SCI after TEVAR, and the prognostic implications of the degree and speed of functional recovery after SCI.…”

Section: Introductionmentioning

confidence: 99%

Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair

DeSart

Scali

Feezor

et al. 2013

Journal of Vascular Surgery

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Objective Spinal cord ischemia(SCI) is a potentially devastating complication of thoracic endovascular aortic repair(TEVAR) that can result in varying degrees of short-term and permanent disability. This study was undertaken to describe the clinical outcomes, long-term functional impact, and influence on survival of SCI after TEVAR. Methods A retrospective review of all TEVAR patients at the University of Florida from 2000–2011 was performed to identify individuals experiencing SCI as defined by any new lower extremity neurologic deficit not attributable to another cause. SCI was dichotomized into immediate or delayed onset, with immediate onset defined as SCI noted upon awakening from anesthesia, and delayed characterized as a period of normal function followed by development of neurologic injury. Ambulatory status was determined using database query, chart review and phone interviews with patients and/or family. Mortality was estimated using life-tables. Results 607 TEVARs were performed for various indications, with 57 patients(9.4%) noted to have postoperative SCI(4.3% permanent). SCI patients were more likely to be older (63.9±15.6 vs. 70.5±11.2;p=.002) and have a number of comorbidities including: COPD, hypertension, dyslipidemia and cerebrovascular disease(P<.0001). Fifty-four patients(95%) had a CSF drain placed at some point in their care, with the majority placed postoperatively(54%). In-hospital mortality was 8.8% for the entire cohort(SCI vs. No SCI;P=.45). Twelve patients developed immediate SCI, 40 had delayed onset, and 5 were indeterminate due to indiscriminate timing from postoperative sedation. Three(25%) immediate SCI patients had measurable functional improvement (FI), while 28(70%) of the delayed-onset patients experienced some degree of neurologic recovery(P=.04). Of the 34 patients with complete data available, 26(76%) reported quantifiable FI, while only 13(38%) experienced return to preoperative baseline. Estimated mean survival(±standard error) for patients with and without SCI was 37.2±4.5 and 71.6±3.9 months(P<.0006), respectively. Patients with FI had a mean survival of 53.9±5.9 months compared to 9.6±3.6 months for those without improvement(P<.0001). Survival and return of neurologic function were not significantly different when comparing patients with pre- and postoperative CSF drains. Conclusions The minority of patients experience complete return to baseline function after suffering SCI with TEVAR, and outcomes in patients without early functional recovery are particularly dismal. Patients experiencing delayed SCI are more likely to have FI and may anticipate similar life-expectancy with neurologic recovery compared to patients without SCI. Timing of drain placement does not appear to have an impact on post-discharge FI or long-term mortality.

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Section: Introductionmentioning

confidence: 99%

Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair

DeSart

Scali

Feezor

et al. 2013

Journal of Vascular Surgery

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“…B. karotidosubklavialer Bypass) erforderlich, um die Durchblutung der A. subclavia sinister wieder herzustellen [8]. Bekannt ist, dass durch die Implantation der Stentgrafts andere Zuflüsse zum Rücken-mark aus segmentalen Arterien (Interkostal-, Lumbal-, Vorderwurzel-und Hinterwurzelarterien) ebenfalls blockiert werden können und sich dadurch komplette oder inkomplette spinale Ischämien ereignen können (Risiko 4-7%) [5]. [1,10,11].…”

Section: Tevarunclassified

“…In diesen Fällen werden Verschlüsse und Scherverletzungen dissektiv veränderter oder auch durch den Stent überbrückter Gefäße vermutet, deren Kollateralversorgung im Myelon nicht sichergestellt werden kann [5]. Die Prognose spinaler Ischämien ist unabhängig von ihrer Auslö-sung grundsätzlich ungünstig, auch wenn selten Spontanremissionen vorkommen.…”

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Remission eines inkompletten Querschnittsyndroms nach thorakaler Stentgraftimplantation

et al. 2012

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Remission eines inkompletten Querschnittsyndroms nach thorakaler Stentgraftimplantation Fallbericht mit LiteraturübersichtBriefe an die Herausgeber Für spinale ischämische Komplikationen im Kontext aortaler Eingriffe mehren sich Berichte über gute klinische Erfolge durch gezielte postinterventionelle Adjustierung von Druckwerten speziell im Liquorraum und des Blutkreislaufs [1, 2]. Korrespondierend hierzu konnten wir nach eintägiger kontinuierlicher Liquordrainage die eindrucksvolle Rückbildung eines inkompletten thorakalen Transversalsyndroms feststellen, das 12 h zuvor bei einem 63-jährigen Patienten im Anschluss an eine notfallmäßi-ge aortale Stenteinlage aufgetreten war und sich trotz stabiler Kreislaufverhältnisse nicht besserte. Gerade wegen der ansonsten beschränkten Behandlungsoptionen bietet sich diese Maßnahme in ausgesuchten Fäl-len zumindest als Heilversuch an. Sie wird hier vor dem Hintergrund bisheriger Literaturmitteilungen kritisch reflektiert und in ein zu evaluierendes therapeutisches Gesamtkonzept eingebettet.

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“…Techniques of left subclavian artery transposition or left carotid to left subclavian artery bypass and preventive cerebrospinal fluid (CSF) drainage prior to TEVAR has been shown to reduce the incidence of SCI. Other endovascular techniques have been used to prevent SCI such as staged coverage of the TAAA or maintaining a flow through an unstented branch vessel that may be embolized at a later date .…”

mentioning

confidence: 99%

The “open branch” technique: A new way to prevent paraplegia after total endovascular repair of thoracoabdominal aneurysm

Krajcer¹,

Echeverría

2016

Cathet Cardio Intervent

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Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta☆

Cited by 24 publications

References 19 publications

Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair

Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair

Remission eines inkompletten Querschnittsyndroms nach thorakaler Stentgraftimplantation

The “open branch” technique: A new way to prevent paraplegia after total endovascular repair of thoracoabdominal aneurysm

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