Contemporary Single-Center Experience With Prophylactic Cerebrospinal Fluid Drainage for Thoracic Endovascular Aortic Repair in Patients at High Risk for Ischemic Spinal Cord Injury

Mazzeffi, Michael; Abuelkasem, Ezeldeen; Drucker, Charles B.; Kalsi, Richa; Toursavadkohi, Shabab; Harris, Donald G.; Rock, Peter; Tanaka, Kenichi A.; Taylor, Bradley S.; Crawford, Robert S.

doi:10.1053/j.jvca.2017.12.002

Cited by 23 publications

(32 citation statements)

References 15 publications

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“…4,5 Indications for CSF drain placement included: all patients being treated with TEVAR (n ¼ 1), all patients being treated with TEVAR without specific contraindications (n ¼ 1), and patients determined by the authors to be high risk for SCI (n ¼ 6). 3,[11][12][13][14][15][16][17] Methods of risk stratification varied between studies but generally were based on the size of the aneurysm and/or involvement of branching or segmental arteries.…”

Section: Protocol and Indication For Csfdmentioning

confidence: 99%

“…Seven of 8 protocols for CSF drainage involved drainage of CSF to a target pressure, between 7 and 12 mm Hg. 3,11,[13][14][15][16][17] Three had limits of CSF volume drained, of 10 to 20 mL/h. 11,12,16 Three studies lowered the target CSF pressure if symptoms of SCI became evident.…”

Section: Protocol and Indication For Csfdmentioning

confidence: 99%

“…3,11,[13][14][15][16][17] Three had limits of CSF volume drained, of 10 to 20 mL/h. 11,12,16 Three studies lowered the target CSF pressure if symptoms of SCI became evident. 3,11,17 In the postoperative period, most continued their intraoperative protocol until removal of the drain at 24 to 72 hours after the operation.…”

Section: Protocol and Indication For Csfdmentioning

confidence: 99%

“…3,11,17 In the postoperative period, most continued their intraoperative protocol until removal of the drain at 24 to 72 hours after the operation. Hiraoka et al 15 and Mazzeffi et al 16 were the only studies that limited postoperative CSF drainage to only symptomatic patients.…”

Section: Protocol and Indication For Csfdmentioning

confidence: 99%

“…Since 2016, several studies have been published on the use of CSFD in TEVAR procedures. 2,3,[12][13][14][15][16][17] The aim of this systematic literature review is to provide an updated summary of the current literature regarding CSFD in endovascular aortic aneurysm repair. The primary objective of the review is to examine the utility of CSFD in adult patients who underwent endovascular aortic aneurysm repair in decreasing rates of SCI, and the secondary objective is to catalog the variations in CSFD protocols used within these studies.…”

Section: Introductionmentioning

confidence: 99%

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Cerebrospinal Fluid Drainage During Endovascular Aortic Aneurysm Repair: A Systematic Review of the Literature and Treatment Recommendations

Malloy

Raghavan

Elder

et al. 2019

Vasc Endovascular Surg

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Introduction: Spinal cord injury (SCI) is a known complication of aortic aneurysm repair. Previous reports indicate that cerebrospinal fluid drainage (CSFD) may reduce incidence of SCI during open aortic aneurysm repair but its utility in endovascular repair remains poorly understood. We performed a systematic review of the literature to examine the protocols and outcomes of CSFD in patients undergoing endovascular aortic aneurysm repair. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were utilized to conduct a systematic literature review. PubMed, Scopus, Ovid, Cochrane, and EMBASE were queried for articles published since 2016 using search terms “(cerebrospinal fluid diversion OR CSF diversion OR lumbar drain OR subarachnoid drain OR spinal) AND (aortic aneurysm AND thoracic AND endovascular OR TEVAR).” Ninety-two articles were identified and screened by 2 independent reviewers, and 23 studies met criteria for full-text review after initial screening. Results: A total of 8 studies met full inclusion criteria for final analysis. Six studies reported incidence of SCI in patients with CSFD and 2 compared SCI incidence between patients with and without CSFD. Protocols for drainage most commonly included draining to a target pressure intra- and postoperatively, between 8 and 12 mm Hg. Incidence of SCI ranged from 0% to 17% in patients with CSFD, and from 0% to 50% in those without CSFD. Rates of CSFD-related complications ranged from <1% to 28%. Conclusion: There may be a protective benefit of CSFD in preventing SCI, but there remains significant variation in drain placement protocols. Significant potential bias exists in the reviewed data. Higher quality studies on the role of CSFD in endovascular aortic aneurysm repair are needed.

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