Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: A report of 486 patients treated from 1987 to 2008

Wynn, Martha M.; Mell, Matthew W.; Tefera, Girma; Hoch, John R.; Acher, Charles W.

doi:10.1016/j.jvs.2008.07.076

Cited by 130 publications

(88 citation statements)

References 24 publications

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“…41,42 However, the systemic anticoagulation required in these patients increases the risk of bleeding, and, in such conditions, CSF drainage and intrathecal manoeuvres can be dangerous. 39,41,42 During the post-operative period, the maintenance of mean arterial pressure (MAP) between 80 and 100 mm Hg has been suggested by high volume centers. 35 After a period of ischaemia caused by cross-clamping, reperfusion injury can occur.…”

Section: Prevention Of Spinal Cord Ischaemia In Open Repairmentioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

861

216

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Section: Prevention Of Spinal Cord Ischaemia In Open Repairmentioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

861

216

View full text Add to dashboard Cite

show abstract

“…[4][5][6] Weaver et al reported that the incidence of SDH was 3.2% after CSF catheter drainage in thoracic aortic aneurysm repairs 4) and Dardik et al reported that a larger volume of CSF (mean 178 mL) drainage in the perioperative period significantly increased risk of SDH. 5,7) However, SDH occurred in our case despite a relatively low total drainage volume of only 125 mL. The mechanism by which SDH coincides with CSF drainage is not completely understood.…”

Section: Discussionmentioning

confidence: 59%

“…[4][5][6] In particular, it has been reported that a larger volume of CSF drainage is a significant risk factor for SDH. 7) Herein, we present a rare case of acute SDH in a patient who did not undergo excessive CSF drainage and recovered without invasive treatment.…”

Section: Introductionmentioning

confidence: 99%

Acute Subdural Hematoma Following Thoracoabdominal Aortic Repair in a Patient with Marfan Syndrome: A Rare Complication of Cerebrospinal Fluid Drainage

Ishikawa

Omoto

et al. 2012

ATCS

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Cerebrospinal fluid (CSF) drainage is a routinely used adjunct in operation of thoracoabdominal aortic aneurysm (TAAA), which may reduce the incidence of perioperative paraplegia by improving spinal cord perfusion. Neurological complications of CSF drainage have been reported, possibly due to excessive CSF drainage, and acute subdural hematoma (SDH) in particular may lead to catastrophic complications. We present a rare case of acute SDH due to CSF drainage that was not excessive, after TAAA repair in a patient with Marfan syndrome, who recovered without invasive treatment.

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“…The overall complication rate of CSFD has been reported to be approximately 5%. The most severe complication was intracranial hemorrhage, which has been associated with a mortality rate as high as 50% (18,20).…”

Section: Risk Factor Analysis For Scimentioning

confidence: 99%

Effects of preemptive cerebrospinal fluid drainage on spinal cord protection during thoracic endovascular aortic repair

Song

Kim

et al. 2017

J. Thorac. Dis.

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Background: Spinal cord injury (SCI) is reported to occur in 3-12% of thoracic endovascular aortic repair (TEVAR) cases, but is a potentially preventable complication of TEVAR for thoracoabdominal pathologies.Although many strategies have been devised to reduce the incidence of SCI, the effectiveness of prophylactic cerebrospinal fluid drainage (CSFD) and left subclavian artery (LSA) revascularization remains controversial.Methods: From 2012 to 2014, 162 patients underwent TEVAR at a single institution. We prospectively collected and retrospectively reviewed the data of 81 patients who underwent preoperative CSFD among the 162 patients. LSA revascularization was routinely used when LSA need to be covered. Preoperative characteristics, intraoperative variables, and outcomes were analyzed.Results: The mean (SD) age of the patients was 60.6 (12.5) years, and 57 patients (70%) were male.Twenty-five patients (31%) presented with degenerative aneurysm; 48 (59%), type B dissection; 5, (6%) penetrating aortic ulcer; and 3 (4%), intramural hematoma. Thirty-six patients (44%) underwent LSA revascularization before TEVAR. Two (2.5%) of the patients who underwent preoperative CSFD had SCI, of whom one recovered ambulatory status at discharge after hypertensive therapy and another had a permanent disability. Prior abdominal aortic aneurysm (AAA) repair tended to relate to SCI (P=0.065), and preoperative aortic rupture was a significant independent risk factor of SCI (P=0.002).Conclusions: Preemptive CSFD as an adjunctive procedure to TEVAR proved to be more effective than selective use of CSFD in other prior reports of SCI cases. Preoperative CSFD is recommended as a prophylactic procedure in patients at high risk of SCI during TEVAR.

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Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: A report of 486 patients treated from 1987 to 2008

Abstract: Strategies that reduce the volume of spinal fluid drainage but still control spinal fluid pressure are helpful in reducing serious complications. Patients with cerebral atrophy are at increased risk for complications of spinal fluid drainage.

Cited by 130 publications

References 24 publications

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Acute Subdural Hematoma Following Thoracoabdominal Aortic Repair in a Patient with Marfan Syndrome: A Rare Complication of Cerebrospinal Fluid Drainage

Effects of preemptive cerebrospinal fluid drainage on spinal cord protection during thoracic endovascular aortic repair

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