Protocol Implementation of Selective PostOperative Lumbar Spinal Drainage after Thoracic Aortic Endograft

Keith, Charles J.; Passman, Marc A.; Patterson, Mark A.; Taylor, Steve M.; Jordan, William D.

doi:10.1016/j.jvs.2010.10.020

Cited by 15 publications

(26 citation statements)

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“…Many studies reported that an increased length of aortic coverage during TEVAR was associated with SCI (2,29-31). Keith et al reported that longer stent graft coverage of the thoracic aorta was associated with an increased incidence of SCI, but no specified length was defined as a factor of increased risk of SCI (2). We demonstrated that preoperative aortic rupture was a risk factor of SCI.…”

Section: Risk Factor Analysis For Scimentioning

confidence: 52%

“…The benefit of prophylactic CSFD in open aortic surgery has been established by 2 meta-analyses (9,11). In TEVAR, the risk of SCI has not been completely established, with reported incidence rates ranging from 3% to 12% (2,12), and spinal cord-protective protocols are less defined than open aortic surgeries. Many studies have reported the incidence of SCI after TEVAR with CSFD, but no randomized trials have examined this issue.…”

Section: Risk Factor Analysis For Scimentioning

confidence: 99%

“…Although the incidence of spinal cord injury (SCI) after TEVAR is lower than that after open repair, it still ranges from 3% to 12% (2) and can lead to profound long-term disability. Various strategies have been suggested to reduce the risk of SCI, including cerebrospinal fluid drainage (CSFD) and maintaining an increased mean arterial pressure (MAP) to improve spinal cord perfusion.…”

Section: Introductionmentioning

confidence: 99%

“…Various strategies have been suggested to reduce the risk of SCI, including cerebrospinal fluid drainage (CSFD) and maintaining an increased mean arterial pressure (MAP) to improve spinal cord perfusion. Protective protocols for SCI are generally used with open repair of thoraco-abdominal aortic aneurysms (TAAA), but these protocols are less defined for TEVAR (2). Current guidelines recommend the use of prophylactic CSFD with TEVAR for long-segment descending thoracic aortic coverage in patients with prior abdominal aortic aneurysm (AAA) repair (3).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Risk Factor Analysis For Scimentioning

confidence: 52%

Section: Risk Factor Analysis For Scimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Song

Kim

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…A prospective study showed the successful implementation of such a protocol with effective reduction in the number of SCI cases [32]. The rate of SCI has been reported to be 3-11% for endovascular repair and is comparable to the rate of open surgery [33,34]. With these adjuncts, the incidence of SCI could be lowered [35][36][37].…”

Section: Current Treatment Concepts General Principlesmentioning

confidence: 99%