What should we do against delayed onset paraplegia following TEVAR?

Kakinohana, Manabu

doi:10.1007/s00540-013-1768-4

Cited by 10 publications

(15 citation statements)

References 26 publications

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“…In this retrospective study, the authors reviewed a total of 724 thoracic or TAAA repair procedures (352 TEVAR patients and 372 open repair patients); they did not show a significant difference in the incidence of SCI between both procedures (4.3% for TEVAR vs 7.5% for open repair, P = 0.08). 15 Indeed, when compared to open repair, not only is the reduction of SCI and paralysis less than expected, delayed (i.e., greater than 24 hours following the procedure) paralysis occurred more frequently than acute paralysis 4, 10, 16 …”

Section: Risk Of Sci In Tevarmentioning

confidence: 99%

“…10 SCI is a dynamic process and the clinical presentation varies between paresis of one limb to full paraplegia, with or without autonomic dysfunction. These manifestations may be either transient (with partial or full recovery) or permanent ( with no regression).…”

Section: Clinical Presentation Of Spinal Cord Injury After Tevarmentioning

confidence: 99%

“…10, 87 However, it is important to determine the best method for increasing the cardiac index. The detrimental effects of increasing cardiac index through expansion of blood volume include a higher CVP (potentially detrimental to spinal cord blood flow, as discussed below) and tissue edema (including spinal cord tissues) while cardiac output augmentation with adrenergic drugs may have potential negative effects at the microcirculatory level of the spinal cord.…”

Section: Perioperative Anesthetic Managementmentioning

confidence: 99%

“…In fact, Kakinohana questioned the role of the CSF drain in prevention of delayed paralysis after TEVAR suggesting that as the mechanism of the delayed paraplegia is not completely understood, its use in this setting cannot be fully justified. 10 …”

Section: Cerebrospinal Fluid Drainagementioning

confidence: 99%

“…8 Although randomized controlled studies showed benefit for CSF drainage in open TAAA repair, 9 its routine use in TEVAR procedures remains uncertain and a topic of considerable debate . 8, 10, 11 …”

Section: Introductionmentioning

confidence: 99%

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Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad

Ramadan

Sayed

et al. 2017

Can J Anesth/J Can Anesth

103

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Purpose Thoracic endovascular aortic aneurysm repair (TEVAR) has become a mainstay of therapy for aneurysmal and other disorders of the thoracic aorta. The purpose of this narrative review article is to summarize the current literature on the risk factors, pathophysiology of spinal cord injury (SCI) following TEVAR, and to discuss various intraoperative monitoring and treatment strategies. Source Articles considered in this review were identified through PubMed using the following search terms: thoracic aortic aneurysm, TEVAR, paralysis+TEVAR, risk factors+TEVAR, spinal cord ischemia+TEVAR, neuromonitoring+thoracic aortic aneurysm, spinal drain, cerebrospinal fluid drainage, treatment of spinal cord ischemia. Principal findings Spinal cord injury continues to be a challenging complication after TEVAR. Its incidence after TEVAR is not significantly reduced compared to open TAAA repair. However, compared to open procedures, delayed paralysis/paresis is the predominant presentation of SCI after TEVAR. The pathophysiology of SCI is complex and remains not fully understood though the evolving concept of the importance of the spinal cord’s collateral blood supply network and its imbalance after TEVAR is emerging as a leading factor in the development of SCI. Cerebrospinal fluid drainage, optimal blood pressure management, and newer surgical techniques are important components of the most current spinal cord protection strategies. Conclusion Further experimental and clinical research is needed to aid in the discovery of novel neuroprotective strategies for protection and treatment of SCI following TEVAR.

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Section: Risk Of Sci In Tevarmentioning

confidence: 99%

Section: Clinical Presentation Of Spinal Cord Injury After Tevarmentioning

confidence: 99%

Section: Perioperative Anesthetic Managementmentioning

confidence: 99%

Section: Cerebrospinal Fluid Drainagementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad

Ramadan

Sayed

et al. 2017

Can J Anesth/J Can Anesth

103

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Complications and Management of the Thoracic Endovascular Aortic Repair

et al. 2020

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Endovascular treatment in thoracic aortic diseases has increased in use exponentially since Dake and colleagues first described the use of a home-made transluminal endovascular graft on 13 patients with descending thoracic aortic aneurysm at Stanford University in the early 1990s. Thoracic endovascular aneurysm repair (TEVAR) was initially developed for therapy in patients deemed unfit for open surgery. Innovations in endograft engineering design and popularization of endovascular techniques have transformed TEVAR to the predominant treatment choice in elective thoracic aortic repair. The number of TEVARs performed in the United States increased by 600% from 1998 to 2007, while the total number of thoracic aortic repairs increased by 60%. As larger multicenter trials and meta-analysis studies in the 2000s demonstrate the significant decrease in perioperative morbidity and mortality of TEVAR over open repair, TEVAR became incorporated into standard guidelines. The 2010 American consensus guidelines recommend TEVAR to be “strongly considered” when feasible for patients with degenerative or traumatic aneurysms of the descending thoracic aorta exceeding 5.5 cm, saccular aneurysms, or postoperative pseudoaneurysms. Nowadays, TEVAR is the predominant treatment for degenerative and traumatic descending thoracic aortic aneurysm repair. Although TEVAR has been shown to have decreased early morbidity and mortality compared with open surgical repair, endovascular manipulation of a diseased aorta with endovascular devices continues to have significant risks. Despite continued advancement in endovascular technique and devices since the first prospective trial examined the complications associated with TEVAR, common complications, two decades later, still include stroke, spinal cord ischemia, device failure, unintentional great vessel coverage, access site complications, and renal injury. In this article, we review common TEVAR complications with some corresponding radiographic imaging and their management.

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2020

Aorta (Stamford)

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Endovascular treatment in thoracic aortic diseases has increased in use exponentially since Dake and colleagues first described the use of a home-made transluminal endovascular graft on 13 patients with descending thoracic aortic aneurysm at Stanford University in the early 1990s. Thoracic endovascular aneurysm repair (TEVAR) was initially developed for therapy in patients deemed unfit for open surgery. Innovations in endograft engineering design and popularization of endovascular techniques have transformed TEVAR to the predominant treatment choice in elective thoracic aortic repair. The number of TEVARs performed in the United States increased by 600% from 1998 to 2007, while the total number of thoracic aortic repairs increased by 60%. As larger multicenter trials and metaanalysis studies in the 2000s demonstrate the significant decrease in perioperative morbidity and mortality of TEVAR over open repair, TEVAR became incorporated into standard guidelines. The 2010 American consensus guidelines recommend TEVAR to be "strongly considered" when feasible for patients with degenerative or traumatic aneurysms of the descending thoracic aorta exceeding 5.5 cm, saccular aneurysms, or postoperative pseudoaneurysms. Nowadays, TEVAR is the predominant treatment for degenerative and traumatic descending thoracic aortic aneurysm repair. Although TEVAR has been shown to have decreased early morbidity and mortality compared with open surgical repair, endovascular manipulation of a diseased aorta with endovascular devices continues to have significant risks. Despite continued advancement in endovascular technique and devices since the first prospective trial examined the complications associated with TEVAR, common complications, two decades later, still include stroke, spinal cord ischemia, device failure, unintentional great vessel coverage, access site complications, and renal injury. In this article, we review commonTEVAR complications with some corresponding radiographic imaging and their management.

show abstract

What should we do against delayed onset paraplegia following TEVAR?

Cited by 10 publications

References 26 publications

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Complications and Management of the Thoracic Endovascular Aortic Repair

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