Spinal cord ischemia after thoracic stent-grafting: causes apart from intercostal artery coverage.

Abstract

BACKGROUND:

Examination of a large collective combined with individual case analyses may give new insights into mechanisms and prevention of spinal cord ischemia (SCI) after thoracic endovascular repair.

METHODS:

In an 11-year period, stent-grafts were implanted in 406 patients for various aortic pathologic conditions. The mean age was 63 years (15-91 years) and 300 (74%) patients were men; 58 patients underwent staged thoracic stent-graft procedures. The length of aorta covered was between 75 and 584 mm (mean, 204 mm). Thoracoabdominal branched or fenestrated stent-grafts were implanted in 11 patients. The left subclavian artery was occluded in 161 patients (39%); this occurred in half of them (n = 78) after protective revascularization. Prophylactic cerebrospinal fluid (CSF) drainage was used selectively in 4 cases; no neuromonitoring was used.

RESULTS:

The incidence of SCI was 2.7% (n = 11); 6 patients (1.5%) had major permanent deficits. Conditions that had a potential influence on SCI were analyzed. Statistical correlation was found for previous conventional or endovascular abdominal aortic aneurysm repair (odds ratio [OR], 4.8), coverage of the entire descending thoracic aorta (OR, 3.6), and implantation of thoracoabdominal branched and fenestrated stent-grafts (OR, 9.5). Individual analyses revealed other conditions that might have played a role, such as embolization into the segmental arteries, severe visceral ischemia, profound hemorrhagic shock, and heparin-induced thrombocytopenia.

CONCLUSIONS:

The incidence of SCI is unexpectedly low despite extensive sacrifice of intercostal arteries. Extended coverage of the thoracic and thoracoabdominal aorta seems to have a higher risk, but other factors may contribute to the individual disaster.

• Authors: Burkhart Zipfel, Semih Buz, Mathias Redlin, Dietrich Hullmeine, Robert Hammerschmidt, Roland Hetzer
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 96 Issue 1 Pg. 31-8 (Jul 2013) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 23673072 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Aorta, Thoracic (surgery)
• Blood Vessel Prosthesis
• Female
• Follow-Up Studies
• Germany (epidemiology)
• Humans
• Incidence
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies
• Spinal Cord Ischemia (diagnosis, epidemiology, etiology)
• Stents
• Thoracic Arteries (surgery)
• Young Adult