Lumbar drain complications in patients undergoing fenestrated or branched endovascular aortic aneurysm repair: Development of an institutional protocol for lumbar drain management

Alqaim, Mohammad; Cosar, Elifce; Crawford, Allison; Robichaud, Devon I.; Walz, J. Matthias; Schanzer, Andres; Simons, Jessica P.

doi:10.1016/j.jvs.2020.02.013

Cited by 27 publications

(16 citation statements)

References 18 publications

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“…CSFD has been indicated as a possible protection tool by different authors 13,14 ; however, other recent publications highlighted the associated risk of both minor and major complications. 4,15,16 ICH is one of these complications; although rare, it is a devastating event and needs to be carefully considered when treating patients for TAAA, since it is associated with a perioperative mortality as high as 38% of our series. The frequency of ICH in patients treated for TAAA with CSFD is similar in other series, and ranges from 2% of Kärkkäinen et al 4 to 6% of Whinn et al 17 after open treatment.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Hemorrhage After Endovascular Repair of Thoracoabdominal Aortic Aneurysm

et al. 2021

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Background Intracranial hemorrhage (ICH) is a rare but devastating complication of thoracoabdominal aortic aneurysm (TAAA) repair with fenestrated/branched endograft (f/bEVAR). The cerebrospinal fluid drainage (CSFD) is considered one of the leading causes; however, other possible concomitant factors have not been individualized yet. The aim of the present work was to evaluate the pattern of ICH events after f/bEVAR for TAAA and to identify possible associated factors. Materials and Methods All f/bEVAR procedures for TAAA performed in a single academic center from 2012 to 2020 were evaluated. ICH was assessed by cerebral computed tomography if neurological symptoms arose. Pre-, intra-, and postoperative characteristics were analyzed in order to identify possible factors associated. Results A total of 135 f/bEVAR were performed for 72 (53%) type I, II, III and 63 (47%) type IV TAAA; 74 (55%) were staged procedures, 101 (73%) required CSFD, and 24 (18%) were performed urgently. The overall 30-day mortality was 8% (5% in elective cases); spinal-cord ischemia occurred in 11(8%) and ICH in 8 (6%) patients. All ICH occurred in patients with CSFD. ICH occurred intraoperatively in 1 case, inter-stage in 4 and after F/BEVAR completion in 3, after a median of 6 days the completion stage. Three (38%) of 8 patients with ICH died at 30 days and ICH was associated with 30-day mortality: odds ratio (OR) 13.2, 95% confidence interval (CI): 2.3–76, p=0.01. The analysis of the perioperative characteristics identified platelet reduction >60% (OR 11, 95% CI 1.6–77, p=0.03), chronic kidney disease (16% vs 0%, p=0.002), and total volume of liquor drained >50 mL (OR 8.1, 95% CI 1.1–69, p=0.03) as associated with ICH. Conclusions Current findings may suggest that ICH is a potential lethal complication of the endovascular treatment for TAAAs and it mainly occurs in patients with CSFD. High-volume liquor drainage, platelet reduction, and chronic kidney disease seems increase significantly the risk of ICH and should be considered during the perioperative period and for further studies.

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Section: Discussionmentioning

confidence: 99%

Intracranial Hemorrhage After Endovascular Repair of Thoracoabdominal Aortic Aneurysm

et al. 2021

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“…A single-center study reported a 16% rate of catheter nonfunctioning. 43 Catheter failure has been attributed to clotting or compression. 44 Catheter failure is a serious concern because drain malfunction has been associated with delayed paralysis.…”

Section: Complications Of Csfdmentioning

confidence: 99%

Spinal Cord Protection for Thoracoabdominal Aortic Surgery

Miller

Patel

Wagener

2022

Journal of Cardiothoracic and Vascular Anesthesia

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“…Lumbar drainage is also an option [153][154][155]. However, large hematomas and obstructive hydrocephalus are contraindications [156].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…A Study has reported high rates of non-functional lumbar cistern drainage and a variety of complications, but fortunately, there are usually no significant long-term sequelae [157]. Repeated lumbar puncture has also been shown to reduce the incidence of CSF infection in aSAH after vascular coiling [153].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

2021

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Hydrocephalus is one of the most common complications of aneurysmal subarachnoid hemorrhage (aSAH), which seriously affects the quality of life and shortens the survival time of affected patients. By reviewing the recent studies on the risk factors of aSAH-associated hydrocephalus, we aimed to explicitly present the pathogenesis of acute and chronic hydrocephalus after aSAH and make a comprehensive list of the associated risk factors of aSAH-associated hydrocephalus and shunt-dependent hydrocephalus. It would help us to better explain the occurrence of hydrocephalus after aSAH, especially hydrocephalus caused by inflammation after bleeding. Many studies have recently suggested that high mobility group box 1 may be an early upstream promoter of inflammatory response after aSAH, which also provides important ideas for us to look for potential drug treatments. The surgery, such as external ventricular drain and lumbar drainage, is the most common and effective treatment. Yet, there are often complications, such as rebleeding and intracranial infection, and the optimal timing of intervention is controversial. Besides, this is also a systematic review of the recent advances in epidemiology, pathogenesis, diagnosis, and management of aSAH-associated hydrocephalus.

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Lumbar drain complications in patients undergoing fenestrated or branched endovascular aortic aneurysm repair: Development of an institutional protocol for lumbar drain management

Cited by 27 publications

References 18 publications

Intracranial Hemorrhage After Endovascular Repair of Thoracoabdominal Aortic Aneurysm

Intracranial Hemorrhage After Endovascular Repair of Thoracoabdominal Aortic Aneurysm

Spinal Cord Protection for Thoracoabdominal Aortic Surgery

Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

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