ESVS: Short-term outcome of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysm

ESVS: Short-term outcome of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysm

ESVS: Short-term outcome of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysm

• RSi Communications
• 26/09/14

as presented at the Annual Meeting of the European Society for Vascular Surgery

While the endovascular repair (ER) of thoracoabdominal aortic aneurysm (TAAA) has low perioperative mortality compared to contemporary open repair, the incidence of spinal cord ischemia is high. 

At ESVS, held in September in Stockholm, scientists from the Vascular Center in Malmo, Sweden, presented their retrospective review of patient charts, pre-, intra-, and post-operative imaging, and other variables for all patients undergoing ER with branched stent grafts for Crawford class I-IV TAAA between 2008 and 2013. 

Sixty-five patients (49 males) were included in the analysis; 45 underwent elective repair, 20 acute. The patients were grouped anatomically according to Crawford class: 11 type I, 25 type II, 15 type III, and 14 type IV. The 30-day mortality was 7.7% (two elective and three ruptures, including one intraoperative death). Twenty-one patients (33%) developed SCI: two type I (20%), 13 type II (52%), three type III (20 %), and three type IV (21%). 

According to the researchers, after the perioperative period, 14 patients had total (n=5) or partial (n=9) recovery from SCI. Some permanent SCI deficit beyond 30 days (n=15, 25%) was more common for type II TAAA (P=0.06); elective patients (P=0.046); longer operative time (P=0.028); more bleeding (P=0.041); and higher contrast volume use (P=0.022). All patients with permanent SCI had received spinal drainage. 

“Further analysis is required on the predictive factors of SCI,” the investigators concluded. “Improved patient selection and better [perioperative] and operative management might improve outcomes.”  

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