Abstract | OBJECTIVE: METHODS: RESULTS: Nine hundred forty-three TEVAR procedures were performed in 869 patients from 2011 to 2020. Post- TEVAR SCI occurred in 7.8% (n = 74) with permanent paraplegia in 1.5%. Older patient age, chronic obstructive pulmonary disease, and previous abdominal aortic surgery were predictive of SCI. Half (n = 37) of SCI episodes resulted in only temporary paralysis/ paraparesis. Rescue postoperative cerebrospinal fluid drains were implanted in 3.7% (n = 35) of procedures and was predicted by higher American Society of Anesthesiologists class, lower serum hemoglobin level, elevated international normalized ratio, bilateral iliac artery occlusion, nonelective procedures, and penetrating atherosclerotic ulcer/intramural hematoma indication. The most commonly used RTs were emergent placement of or increased drainage from an existing cerebrospinal fluid drain (87.8%), induced/permissive hypertension (77.0%), corticosteroid bolus (36.5%), and naloxone infusion (33.8%). Neurologic improvement occurred in 68.9% (n = 51/74). New/increased drainage was associated with improved SCI outcome. CONCLUSIONS: Permanent paraplegia from post- TEVAR SCI is rare (1.5%). Older patients with comorbidities carry greater post- TEVAR SCI risk. SCI symptoms improved/resolved with CSFD and multimodal RT in 68.9% of patients, but no intervention was independently associated with improvement. TEVAR centers should have robust protocols for timely and safe CSFD placement to augment RT strategies for SCI.
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Authors | John R Spratt, Kristen L Walker, Dan Neal, George J Arnaoutakis, Tomas D Martin, Martin R Back, Yury Zasimovich, Michael Franklin, Zain Shahid, Gilbert R Upchurch Jr, Salvatore T Scali, Thomas M Beaver |
Journal | The Journal of thoracic and cardiovascular surgery
(J Thorac Cardiovasc Surg)
(Nov 05 2022)
ISSN: 1097-685X [Electronic] United States |
PMID | 36509568
(Publication Type: Journal Article)
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Copyright | Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. |