Permissive Hypertension and Collateral Revascularization May Allow Avoidance of Cerebrospinal Fluid Drainage in Thoracic Endovascular Aortic Repair

Weissler, E. Hope; Voigt, Soraya L.; Raman, Vignesh; Jawitz, Oliver K.; Doberne, Julie; Anand, Jatin; Plichta, Ryan P.; Gaca, Jeffrey G.; McCann, Richard L.; Hughes, G. Chad

doi:10.1016/j.athoracsur.2020.04.101

Cited by 30 publications

(29 citation statements)

References 25 publications

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“…Another institution published an experience with a series of 223 patients who underwent TEVAR using a protocol without preoperative spinal drain placement, allowing for permissive hypertension, and focusing on preservation of the left subclavian artery flow, and reported 0% SCI. 5 Average aortic coverage in this study was 23.0 cm.…”

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confidence: 62%

Commentary: Protecting the artery of Adamkiewicz: Highest imperative

2021

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confidence: 62%

Commentary: Protecting the artery of Adamkiewicz: Highest imperative

2021

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“…Since Coselli's study in 2002, CSFD has become the protocol for several treatment centers for aortic diseases (Coselli et al, 2002). CSFD has been used to decrease the intra-spinal canal pressure, thereby increasing spinal cord perfusion pressure (Weissler et al, 2020). However, the effectiveness is controversial and there is a lack of data in the literature (Khan and Stansby, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…The importance of CSFD for prevention of SCI after thoracic endovascular aortic repair (TEVAR) remains unclear (Hiratzka et al, 2010). Permissive hypertension and collateral revascularization may allow avoidance of CSFD and its risks (Weissler et al, 2020). Since the spinal cord has multiple vascular collaterals, the probability of SCI arising from an interruption of a certain blood supply is low, unless obstruction to blood supply occurred on multiple levels.…”

Section: Discussionmentioning

confidence: 99%

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Spinal Cord Ischemia After Endovascular Aortic Repair – A Case Report

Soares¹,

Drumond²,

Souza³

et al. 2021

FMCR

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Spinal cord ischemia (SCI) is a devastating complication after aortic aneurysm repair. Even in a less invasive procedure, as endovascular aneurysm treatment, paraplegia is still a concern. SCI is associated with perioperative hemodynamic instability and damage of the main or collateral spinal cord circulation. This is a case report of a patient with complicated aortic dissection who underwent several procedures (open surgeries and endovascular treatments) and developed paraplegia after the last endovascular repair. We highlight the cerebrospinal fluid drainage as a therapeutic procedure rather than a prophylactic one, associated with maintenance of hematimetric levels, permissive hypertension and administration of L-type calcium inhibitor. We also discuss spinal cord perfusion and motor evoked potentials monitoring during aortic aneurysm repair. The patient's condition improved, he was discharged home 15 days after the procedure. Three months after discharge the patient was able to walk alone without difficult.

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“…Vascular access was through one or both sides with direct surgical femoral exposure. Spinal cord protection in elective procedures comprised preoperative cerebrospinal fluid (CSF) drainage (intracranial pressure �10 mmHg) in cases where aorta coverage exceeded 20 mm, the LSA was covered, there was prior infrarenal repair or internal arteries occlusion; and postoperative maintenance of mean arterial blood pressure �75-80 mmHg for all patients [12][13][14].…”

Section: Device Description and Proceduresmentioning

confidence: 99%

Early results of a low-profile stent-graft for thoracic endovascular aortic repair

et al. 2020

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Purpose To assess outcomes of a low-profile thoracic stent-graft in the treatment of thoracic aortic pathologies. Methods A retrospective analysis of all consecutive patients with aortic thoracic pathologies treated with the RelayPro device in two university hospitals between October 2018 and July 2019. Results 23 patients (65% men; mean age 63.4 ± 15 years) were treated. Pathologies included aortic dissections (n = 10), 5 residual type A (22%) and 5 type B (22%), 6 degenerative aortic aneurysms (26%), 4 penetrating aortic ulcers (17%), and aortic erosion, intramural hematoma and aortic rupture (n = 1 and 4% in each case). Two cases (9%) were emergent and two urgent. Proximal landing was achieved in zones 0 (4%), 1 (4%), 2 (43%), and 3 (26%). Five grafts were frozen elephant trunk extensions. Technical success was 100% with accurate device deployment in the intended landing zone of the aortic arch in all 23 patients and with no Ia/III endoleaks and three (13%) type II endoleaks. Apposition was adequate in 96%. Two patients had post-implantation syndromes (one fever, one leukocytosis). Mean follow-up was 11.6 ± 3.7 months (range, 2–16) with no other complications, secondary interventions or conversions to open surgery. There was no 30-day mortality and no aortic-related mortality; all-cause mortality was 4% during follow-up. Conclusion A 3–4 French reduced profile in the current generation of stent-grafts facilitates TEVAR particularly in patients with smaller vessels access. Early safety and effectiveness outcomes are favorable, even in endpoints such as deployment accuracy and apposition which may be surrogates for longer-term clinical success and durability.

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Permissive Hypertension and Collateral Revascularization May Allow Avoidance of Cerebrospinal Fluid Drainage in Thoracic Endovascular Aortic Repair

Cited by 30 publications

References 25 publications

Commentary: Protecting the artery of Adamkiewicz: Highest imperative

Commentary: Protecting the artery of Adamkiewicz: Highest imperative

Spinal Cord Ischemia After Endovascular Aortic Repair – A Case Report

Early results of a low-profile stent-graft for thoracic endovascular aortic repair

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