Systematic Review of the Effect of Cerebrospinal Fluid Drainage on Outcomes After Endovascular Descending Thoracic/Thoraco-Abdominal Aortic Aneurysm Repair

Frankort, Jelle; Mees, Barend; Doukas, Panagiotis; Keszei, András; Kontopodis, Nikolaos; Antoniou, George Α.; Jacobs, Michael J.; Gombert, Alexander

doi:10.1016/j.ejvs.2023.05.006

Cited by 5 publications

(2 citation statements)

References 51 publications

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“…The fistulas that develop following TEVAR are most commonly to the airway (aortobronchial or aortopulmonary) or to the esophagus (aortoesophageal) with rates around 0.6% for airway fistulas and 1.5% for esophageal fistulas. 93 94 In both infections and fistulas, the endograft is often fully removed and the graft being placed is soaked in antibiotic solution to minimize risk of further infection.…”

Section: Long-term Complications and Considerationsmentioning

confidence: 99%

Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms

Gorton,

Keshavamurthy,

Saha

2024

Int J Angiol

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The thoracic aorta is a dynamic structure composed of the aortic root, ascending aorta, aortic arch, and descending aorta. It is subject to the pressure and volume of the cardiac cycle and susceptible to atherosclerotic and aneurysmal changes. With these changes, the risk for acute aortic syndromes increases, thus creating the impetus for earlier interventions. The previous standard of open surgical repair has undergone a transition in recent years toward endovascular repair being favored in the descending and abdominal aortas with ongoing investigation into approaches for the ascending and aortic arch. These therapies have been shown to improve early mortality and morbidity outcomes with the caveat of more interventions compared with open surgery. We undertook this review to analyze the current data available regarding long-term outcomes in patients undergoing endovascular repair for thoracic aortic disease. The data support long-term benefit of endovascular repair for thoracic aortic disease. The primary indications identified for reintervention are endoleak and further aneurysmal degeneration. As the devices available for endovascular repair evolve, ongoing review of these outcomes will be necessary. It will also be important to trend the results as further techniques become available for endovascular repair of the ascending aorta and aortic arch.

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Section: Long-term Complications and Considerationsmentioning

confidence: 99%

Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms

Gorton,

Keshavamurthy,

Saha

2024

Int J Angiol

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“…Despite these advancements, postoperative spinal cord ischemia (SCI) with its catastrophic sequelae of paraplegia and paraparesis occurring in 2.5–8%, has remained a major concern [ 3 ]. Some clinical studies have suggested that prophylactic cerebrospinal fluid drainage (CSFD), which refers to drainage performed preoperatively in all patients (routine) or only in high-risk patients (selective), might decrease the postoperative risk of SCI after TEVAR [ 4 ]. However, the use of prophylactic CSFD has been debated in reported studies [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair

Zheng,

Lin,

Cheng

et al. 2024

J Cardiothorac Surg

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Objective The aim of the present systematic review was to determine whether prophylactic use of cerebrospinal fluid drainage (CSFD) contributes to a lower rate of spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). Methods PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched to identify all relevant studies reported before May 7, 2023. A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42023441392). The primary outcome was permanent SCI. Secondary outcomes were temporary SCI and 30-day/in-hospital mortality. The data were presented as the pooled event rates (ERs) and 95% confidence intervals (CIs). Results A total of 1008 studies were screened, of which 34 studies with 2749 patients were included in the present analysis. The mean Downs and Black quality assessment score was 8.71 (range, 5–12). The pooled rate of permanent SCI with prophylactic CSFD was identical to that without prophylactic CSFD (2.0%; 95% CI, 1.0–3.0; P = 0.445). No statistically significant difference was found between the rates of permanent SCI with routine vs. selective prophylactic CSFD (P = 0.596). The pooled rate of temporary SCI was 1.0% (95% CI, 0.00–1.0%). The pooled rate for 30-day or in-hospital mortality was not significantly different (P = 0.525) in patients with prophylactic CSFD (4.0, 95% CI 2.0–6.0) or without prophylactic CSFD (5.0, 95% CI 2.0–7.0). Conclusions The systematic review has shown that prophylactic CSFD was not associated with a lower rate of permanent SCI and 30-day or in-hospital mortality after TEVAR for TBAD.

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