TEVAR following prior abdominal aortic aneurysm surgery: Increased risk of neurological deficit

Abstract

Prior infrarenal AAA repair is associated with dramatic increased risk of SCI after TEVAR compared to patients without prior AAA surgery. Preoperative renal insufficiency appears to be an important predictor of SCI after TEVAR in patients with prior AAA repair. A thorough understanding of the risk profile in patients requiring TEVAR following prior AAA surgery is essential when determining appropriate surgical recommendations. If the diameter and rupture risk are large and TEVAR is indicated, the best available care should be offered for maximal protection of the spinal cord in these patients.

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

“…In addition, a multicenter cohort study of 72 patients who underwent TEVAR for treatment of degenerative thoracic aortic aneurysm disease after prior AAA repair also noted an association between renal function and development of SCI. 27 Symptoms of SCI occurred in 12.5% of these patients, with renal insufficiency again serving as an important risk factor for SCI (P ϭ .011). Although renal insufficiency has also long been noted to be a major risk factor for SCI after open thoracoabdominal aortic aneurysm repair, [30][31][32] the precise mechanism is less clear.…”

“…9,11,17,25,26 Prior AAA repair can similarly lead to diminished spinal cord perfusion by compromising pelvic and hypogastric collaterals. 13,25,27,28 Moreover, degenerative aneurysms have been associated with an increased risk for SCI, given that these patients tend to have fewer patent intercostal arteries compared to those with postdissection thoracic aneurysms. 29 In the present study, patients with preoperative CRI were significantly more likely to develop SCI.…”

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…44 Although rare in ATBAD patients, SCI is related to the extent of aortic coverage, history of previous aortic surgery and the presence of hypotension at initial presentation. 47 Arm ischaemia, paraparesis, and paraplegia may occur from LSA or intercostal artery occlusion, which may require revascularisation. 49,50 (see Section 2.4.4).…”

A Rare Complication of Spinal Cord Ischemia Following Endovascular Aneurysm Repair of an Infrarenal Abdominal Aortic Aneurysm with Arteriosclerosis Obliterans: Report of a Case

“…CSF drainage is performed in order to decrease the cerebrospinal pressure thereby leading to an improvement of spinal cord perfusion. 4) Spinal cord perfusion pressure is the mean arterial blood pressure (MAP) minus the spinal fluid pressure; therefore, CSF drainage leads to the improvement of spinal cord perfusion. Steroids are used to suppress inflammation and reduce edema of the ischemic spinal cord.…”