Letter Regarding Article by Katzen et al, “Endovascular Repair of Abdominal and Thoracic Aortic Aneurysms”
To the Editor:
The comprehensive review of endovascular surgical techniques for repair of abdominal and thoracic aortic aneurysms by Katzen and colleagues1 provides important information on the current status and future directions of this new, less-invasive technology. In their discussion of the management of descending thoracic aortic aneurysms, the authors reported rates of postoperative paraplegia of 0% to 5% for the endovascular procedures and rates of 5% to 25% for open surgical repair, an obviously important difference for a serious complication that adversely affects survival and quality of life. The cited rates for open repair were obtained from 4 referenced articles published between 1978 and 1993. Review of these articles indicates that the rates of paraplegia for aneurysms involving only the descending thoracic aorta treated by several different techniques ranged from 2.3% to 6.4%. The single series reporting the highest prevalence of paraplegia (16%) (Reference 64) involved only patients with thoracoabdominal aortic aneurysms, none of which would be suitable for endovascular repair according to current indications. Other studies of open repair of aneurysms confined to the descending thoracic aorta in which distal aortic perfusion was used as an adjunct to reduce the prevalence of spinal cord ischemic injury reported rates of paraplegia between 0% and 3.9% in 581 patients.2–5
Although endovascular repair of aneurysms of the descending thoracic aorta appears to offer important advantages over open operations, particularly in high-risk patients, as emphasized by Katzen and colleagues,1 there is as yet no clear evidence to indicate that this technique is associated with a lower risk of paraplegia. The frequency with which this complication occurs with these 2 surgical techniques will only be determined with certainty in prospective, randomized trials.