Risk of spinal cord ischemia after fenestrated or branched endovascular repair of complex aortic aneurysms

Σπανός, Κωνσταντίνος; Kölbel, Tilo; Kubitz, Jens C.; Wipper, Sabine; Konstantinou, Nikolaos; Heidemann, Franziska; Rohlffs, Fiona; Debus, Sebastian; Tsilimparis, Nikolaos

doi:10.1016/j.jvs.2018.05.216

Cited by 114 publications

(69 citation statements)

References 26 publications

(43 reference statements)

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“…Mortality and morbidity after open and endovascular TAAA Repair remain high 31,32 . In our observational study including TAAA patients, AKI was the most frequent complication after surgery and showed a crucial association with additional severe complications.…”

Section: Discussionmentioning

confidence: 99%

SLPI - a Biomarker of Acute Kidney Injury after Open and Endovascular Thoracoabdominal Aortic Aneurysm (TAAA) Repair

Averdunk

Rückbeil

Zarbock

et al. 2020

Sci Rep

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Acute kidney injury (AKi) is a relevant complication following thoracoabdominal aortic aneurysm repair (tAAA). Biomarkers, such as secretory leucocyte peptidase inhibitor (SLpi), may enable a more accurate diagnosis. in this study, we tested if SLpi measured in serum is an appropriate biomarker of AKi after TAAA repair. In a prospective observational single-center study including 33 patients (51.5% women, mean age 63.0 ± 16.2 years) undergoing open and endovascular aortic aneurysm repair in 2017, SLPI was measured peri-operatively (until 72 h after surgery). After surgery, the postoperative complications AKI, as defined according to the KDIGO diagnostic criteria, sepsis, death, MACE (major cardiovascular events) and, pneumonia were assessed. in a subgroup analysis, patients with preexisting kidney disease were excluded. Of 33 patients, 51.5% (n = 17) of patients developed AKI. Twelve hours after admission to the intensive care unit (ICU), SLPI serum levels were significantly increased in patients who developed AKI. Multivariable logistic regression revealed a significant association between SLPI 12 hours after admission to ICU and AKI (P = 0.0181, OR = 1.055, 95% CI = 1.009-1.103). The sensitivity of SLPI for AKI prediction was 76.47% (95% CI = 50.1-93.2) and the specificity was 87.5% (95% CI = 61.7-98.4) with an AUC = 0.838 (95% CI = 0.7-0.976) for an optimal cut-off 70.03 ng/ml 12 hours after surgery. in patients without pre-existing impaired renal function, an improved diagnostic quality of SLpi for AKI was observed (Sensitivities of 45.45-91.67%, Specificities of 77.7-100%, AUC = 0.716-0.932). there was no association between perioperative SLpi and the incidence of sepsis, death, MAce (major cardiovascular events), pneumonia. this study suggests that SLpi might be a post-operative biomarker of AKi after tAAA repair, with a superior diagnostic accuracy for patients without preexisting impaired renal function.Open and endovascular repair of thoracoabdominal aortic aneurysm (TAAA) is related to a high risk of postoperative complications. With an incidence ranging between 13 and 42%, acute kidney injury (AKI) is one of the most common complications and closely associated with increased mortality and cardiovascular morbidity 1-3 . The early detection of impaired kidney function and other organ dysfunctions may enable an immediate start of specific treatment bundles. The diagnosis of AKI is mainly based on patients' urine output and serum creatinine levels. Serum creatinine is an established, yet controversial biomarker due to its delayed increase and low sensitivity for the detection of an impaired kidney function 4-6 . In this context, the necessity of clinically available early and reliable biomarkers of AKI becomes evident.Secretory leucocyte peptidase inhibitor (SLPI) is a protease inhibitor and regulator of innate and adaptive immunity 7 . It is synthesized predominantly in immune and epithelial cells of mucosal surfaces, such as the pancreas and kidney 8 . Elevated serum SLPI levels have been observed in acu...

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Section: Discussionmentioning

confidence: 99%

SLPI - a Biomarker of Acute Kidney Injury after Open and Endovascular Thoracoabdominal Aortic Aneurysm (TAAA) Repair

Averdunk

Rückbeil

Zarbock

et al. 2020

Sci Rep

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“…The most important reason to perform a carotidesubclavian bypass is to reduce the risk for spinal cord ischaemia and posterior stroke. 17,18 Another advantage is the prevention of upper extremity ischaemia. However, as almost all patients that were treated at the authors' centre with a hybrid procedure for aortic arch pathologies underwent revascularisation of the supra-aortic vessels, a conclusion on these points could not be drawn.…”

Section: Discussionmentioning

confidence: 99%

Cervical Debranching in the Endovascular Era: A Single Centre Experience

Konstantinou¹,

Debus²,

Vermeulen³

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS With one of the largest series of cervical debranching operations with 211 cases, the results of a single centre's experience are presented. Focusing on post-operative complications and graft patency, attempts are made to identify factors that influence outcome and discuss the findings. It is concluded that cervical debranching has some relevant local complications but that long-term patency is exceptional. Objective/Background: Debranching of the supra-aortic arteries is a common practice either as part of a hybrid treatment of aortic arch pathology or owing to arterial occlusive disease. Results of the debranching techniques have not been reported frequently. Methods: This was a retrospective single centre study of all consecutive patients with cervical debranching procedures as part of hybrid aortic arch repair. Results: Between 2010 and 2017, 201 patients underwent 211 cervical debranching procedures in a tertiary centre. Mean AE SD patient age was 67.7 AE 10.7 years (70.6% males; n ¼ 142/201) and mean AE SD body mass index (BMI) was 26.3 AE 5. In 78.7% of the cases carotidesubclavian bypass was performed alone (n ¼ 166/211) followed by transposition of the subclavian artery to the ipsilateral carotid (n ¼ 17/211; 8.1%) and in 28 cases (13.3%) a combination of procedures was performed. Twenty-four cases (11.4%) were complicated with local bleeding and 21 cases required re-intervention (10.4%). Nineteen patients (9.5%) developed local peripheral neurological damage post-operatively. Eight patients (3.8%) developed a chylous fistula and five (2.4%) presented with a local wound infection. One patient (0.5%) developed a bypass graft infection. The thirty day mortality was 7.6% (n ¼ 16/211): one death occurred after isolated debranching without thoracic endovascular aneurysm repair (TEVAR; 0.5%). Whether the hybrid procedures were undertaken in a single stage (simultaneous TEVAR and cervical debranching) or two stage fashion appeared to have a significant impact on 30 day mortality (single stage n ¼ 9/60 [15%] vs. debranching alone or two stage hybrid procedures n ¼ 7/144 [4.9%]; p ¼ .018). The major stroke incidence was 4.3% (n ¼ 9/211); no strokes occurred after isolated debranching. Stroke was correlated with longer operating times (odds ratio [OR] 1.006; 95% confidence interval [CI] 1.000e1.011; p ¼ .045) and higher BMI (OR 1.195; 95% CI 1.009e1.415; p ¼ .039). Mean AE SD follow up was 15 AE 17 months (range 0e89 months). Primary cumulative graft patency during follow up was 98.1% (n ¼ 207/211) and secondary patency was 100%. Conclusion: The results of cervical debranching procedures showed not only excellent patency rates, but also a significant rate of local complications. Carotidesubclavian bypass appeared to be safer with significantly fewer post-operative complications. Staged hybrid procedures also seemed to be safer.

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“…Maßnahmen, die zu einer Verringerung der Inzidenz einer peri-und postoperativen Spinalischämie führen, sind bspw. eine postoperative Blutdruckregulierung, mehrzeitige operative Verfahren sowie der Einsatz von spinalen Liquordrainagen [5,9,10].…”

Section: Einführungunclassified

Aortenaneurysma: fenestrierte/gebranchte abdominale EVAR (fbEVAR) und fenestrierte/gebranchte thorakale EVAR (fbTEVAR). Ist die komplette endovaskuläre Therapie schon da?

Mehmedovic¹,

Konstantinou²,

Jerkku³

et al. 2020

Zentralbl Chir

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ZusammenfassungFünf Jahre nach der ersten endovaskulären Aortenrekonstruktion (EVAR) berichten Park et al. über die erste Implantation einer fenestrierten Endoprothese. In der Zwischenzeit wurden mehrere fortgeschrittene Generationen von fenestrierten und gebranchten Prothesen entwickelt. Diese können in den meisten Fällen in 2 Gruppen unterteilt werden. Zur 1. Gruppe gehören die „custom-made“-Prothesen, die für elektive Operationen individuell für Patienten mit spezifischer Anatomie hergestellt werden. Eine 2. Gruppe bilden die sog. „off-the-shelf“-Prothesen, die sich durch vom Hersteller vergebene Charakteristika im Sinne von Länge, Breite und Durchmesser auszeichnen und bei allen Prothesen gleich sind. Die offene gefäßchirurgische Therapie der thorakoabdominellen Aortenaneurysmen ist selbst bei elektiven Eingriffen mit relevanter Mortalität und Morbidität assoziiert. Die Entwicklung von endovaskulären Modalitäten wie z. B. fenestrierte oder gebranchte endovaskuläre Aortenrekonstruktionen (F-EVAR, B-EVAR) ermöglichten die Nutzung weniger invasiver Prozeduren für die Behandlung der komplexen Aortenpathologien sowohl im thorakoabdominalen Abschnitt als auch im Aortenbogen. Eine umfassende Behandlung aller Segmente der Aorta mit endovaskulären Techniken wurde noch nicht vollständig evaluiert. Das Ziel dieses Artikels ist die Präsentation eines Überblicks der zurzeit verfügbaren endovaskulären Möglichkeiten der Behandlung von komplexen abdominellen und thorakoabdominellen Aortenaneurysmen, die sowohl eine komplexe thorakale als auch komplexe abdominale Versorgung benötigen.

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Risk of spinal cord ischemia after fenestrated or branched endovascular repair of complex aortic aneurysms

Cited by 114 publications

References 26 publications

SLPI - a Biomarker of Acute Kidney Injury after Open and Endovascular Thoracoabdominal Aortic Aneurysm (TAAA) Repair

SLPI - a Biomarker of Acute Kidney Injury after Open and Endovascular Thoracoabdominal Aortic Aneurysm (TAAA) Repair

Cervical Debranching in the Endovascular Era: A Single Centre Experience

Aortenaneurysma: fenestrierte/gebranchte abdominale EVAR (fbEVAR) und fenestrierte/gebranchte thorakale EVAR (fbTEVAR). Ist die komplette endovaskuläre Therapie schon da?

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