Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) Registry

Buth, Jacob; Harris, Peter L.; Hobo, Roel; Eps, Randolph van; Cuypers, Philippe W.M.; Duijm, Luciën E. M.; Tielbeek, X.

doi:10.1016/j.jvs.2007.08.020

Cited by 559 publications

(428 citation statements)

References 49 publications

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“…Therefore, we cannot conclude if either of these prophylactic measures influence our SCI rate as suggested by Hnath et al and Both at al in their studies. [6,15] Meanwhile, Scott and colleagues [16]advocate that maintenance of norm tension peri-and postoperatively is critical in preventing SCI. In addition, they highlighted the importance of regular monitoring and assessment for clinical signs of SCI which should prompt early prophylactic measures.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of paraplegia or paraparesis as a consequence has been reported to range from 2.5% to 8%. [5][6][7] Extensive coverage of the thoracic aorta, occlusion of the Left Subclavian Artery (LSA) or Hypo gastric Artery and prolonged hypotension are some of the risk factors associated with postoperative spinal ischemia. Some authors use spinal drainage in high risk patients but data shows no significant benefit in support of routinely using this technique.…”

Section: Introductionmentioning

confidence: 99%

“…[7,8] Others recommend routine revascularisation of the LSA if it is to be covered by an endograft. [6,9] Our unit is a tertiary trauma centre in the northeast Scotland and serves a population of approximately 525,000. We started performing TEVAR in 2012 for both elective and emergency cases.…”

Section: Introductionmentioning

confidence: 99%

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The Northeast Scotland’s 5-year TEVAR Experience

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Northeast Scotland’s 5-year TEVAR Experience

2017

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“…This advantage is of particular relevance in the treatment of acute Stanford type B dissections, where the incidence associated with traditional surgery is between 14 -19% [18][19]. Conversely, for the treatment of isolated descending thoracic aneurysms, the two treatment techniques have a comparable incidence of paraplegia, reported to be between 0-4% [20] and 2.5% [21] respectively.…”

Section: Neurological Complicationsmentioning

confidence: 99%

Endovascular Treatment of Descending Thoracic Aortic Aneurysms

Coppi¹,

Gennai²,

Silingardi³

et al. 2013

Aortic Aneurysm - Recent Advances

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“…1 This complication occurs more frequently when the left subclavian artery (LSA) is covered, compromising anterior cord blood flow from the left vertebral artery. 2 Prophylactic revascularization utilizing left common carotid artery (LCA) to LSA bypass/transposition has been reported to reduce the incidence of paraplegia, particularly during long segment stenting of the thoracic aorta.…”

mentioning

confidence: 99%

Transesophageal echocardiography imaging of subclavian to carotid artery transposition

Dobson¹,

Moore²,

Maher³

2010

Can J Anesth/J Can Anesth

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Paraplegia following endovascular management of thoracic aortic aneurysms is variably reported to occur in 2.7% (range 0-12%) of cases and is believed to be secondary to reduction of anterior spinal artery flow and spinal cord ischemia. 1 This complication occurs more frequently when the left subclavian artery (LSA) is covered, compromising anterior cord blood flow from the left vertebral artery. 2 Prophylactic revascularization utilizing left common carotid artery (LCA) to LSA bypass/transposition has been reported to reduce the incidence of paraplegia, particularly during long segment stenting of the thoracic aorta.A method for visualizing aortic arch branches with transesophageal echocardiography (TEE) has been described in which the LCA and the LSA were successfully identified in 98% and 100% of cases, respectively. 3 Using a similar approach, we report a case in which flow through the LSA-LCA transposition is documented using TEE.A 69-yr-old male presented with pseudo-aneurysmal degeneration of a type B dissection and required endovascular repair of his thoracic aorta. As the planned endovascular procedure would cover the origin to the LSA, the LSA was transposed and then anastomosed to the LCA.Two days following surgery, the patient developed back pain suggestive of impending rupture of his pseudo-aneurysm and underwent urgent stenting of his thoracic aorta. With TEE guidance, verification of the functioning transposition could be assured both before and following stent deployment (video; available as electronic supplementary material).The preservation of collateral circulation to the spinal cord is essential if paraplegia is to be avoided in patients undergoing extensive stenting of the thoracic aorta. In cases requiring long thoracic endovascular repair where the origin of the LSA is covered, the presence of a functioning arterial bypass (Figure 1) helps preserve flow through the left vertebral artery and anterior spinal arterial network and reduces the incidence of paraplegia. In suitable patients, TEE can be used to confirm the presence of a functioning arterial conduit from the carotid artery to the subclavian artery.Competing interests None declared.

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Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) Registry

Cited by 559 publications

References 49 publications

The Northeast Scotland’s 5-year TEVAR Experience

The Northeast Scotland’s 5-year TEVAR Experience

Endovascular Treatment of Descending Thoracic Aortic Aneurysms

Transesophageal echocardiography imaging of subclavian to carotid artery transposition

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