Early experience with automatic pressure-controlled cerebrospinal fluid drainage during thoracic endovascular aortic repair.

Abstract

PURPOSE:

To report initial experience with automatic pressure-controlled cerebrospinal fluid drainage (CSFD) during thoracic endovascular aortic repair (TEVAR).

METHODS:

A prospective nonrandomized study enrolled 30 consecutive patients (median age 68 years, range 42-89; 18 men) who underwent TEVAR between March 2012 and July 2013 and were considered to be at high risk for postoperative spinal cord ischemia (SCI), fulfilling 2 of the following criteria: stent-graft length >20 cm, left subclavian artery coverage, and previous infrarenal aortic repair. All patients received perioperative CSFD via the LiquoGuard system. The protocol aimed for a CSF pressure of 10 mm Hg and duration of CSFD of 3 or 7 days in asymptomatic or symptomatic patients, respectively. Muscle strength of the lower extremities was assessed with the Oxford muscle strength grading scale.

RESULTS:

Completion of the CSFD protocol was achieved in 26 (87%) of 30 patients. CSFD was prematurely stopped due to catheter dislocation in 1 patient and bloody spinal fluid in 3 patients. CSFD was performed for a median of 3 days (range 1-7). Median total CSFD volume was 714 mL (range 13-2369), with a median 192 mL drained per 24 hours. The SCI rate was 3% (1/30). CSFD-related complications were observed in 33% of the patients: 1 fatal intracranial hemorrhage, 3 bloody spinal fluid episodes, 3 persistent CSF leaks requiring epidural blood patch, and 3 post lumbar puncture headaches. Mortality during a median follow-up of 16 months (range 10-25) was 3% (1/30).

CONCLUSION:

Prophylactic CSFD was associated with a low SCI rate in a high-risk patient collective undergoing TEVAR. Monitoring and drainage by an automatic modus was feasible, reproducible, and reliable but associated with relevant drainage-associated complications.

• Authors: Drosos Kotelis, Claudio Bianchini, Bence Kovacs, Thomas Müller, Moritz Bischoff, Dittmar Böckler
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 22 Issue 3 Pg. 368-72 (Jun 2015) ISSN: 1545-1550 [Electronic] United States
• PMID: 25862367 (Publication Type: Evaluation Study, Journal Article)
• Copyright: © The Author(s) 2015.

Topics

• Adult
• Aged
• Aged, 80 and over
• Aorta, Thoracic (surgery)
• Automation
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation, mortality)
• Cerebrospinal Fluid Pressure
• Drainage (adverse effects, instrumentation, methods, mortality)
• Endovascular Procedures (adverse effects, instrumentation, mortality)
• Equipment Design
• Feasibility Studies
• Female
• Humans
• Male
• Middle Aged
• Monitoring, Intraoperative
• Prospective Studies
• Prosthesis Design
• Risk Factors
• Spinal Cord Ischemia (diagnosis, etiology, mortality, prevention & control)
• Spinal Puncture
• Stents
• Time Factors
• Transducers, Pressure
• Treatment Outcome