Abstract 3052: Efficacy of Cerebrospinal Fluid Drainage and Naloxone for Endovascular Repair of Thoraco-Abdominal Aortic Aneurysms
Postoperative paraplegia is a devastating complication of inferior descending thoracic (iDTA) and thoracoabdominal aortic aneurysms (TAAA) operation. Despite refinements in surgical technique for spinal protection, the risk of postoperative neurologic deficit remains significant. Postoperative paraplegia in endovascular aortic repair (EVAR) was improved remarkably than conventional operations, but this method has an incidence of 5%. Cerebrospinal fluid drainage (CSFD) and dosage of Naloxone might be effective to protect spinal cord from ischemia. But these adjuncts are not clear yet in EVAR. A purpose of this study is to evaluate the impact of CSFD on the incidence of spinal cord injury after EVAR of iDTA and TAAA. [Method] 625 patients received EVAR from January 1996 to March 2007. In these patients, the cases that stent-graft ending was inserted in periphery ahead of Th12 were 93. The average age was 73.4 years. Preoperative complications included 10 cases of cerebrovascular disorder, 9 cases of COPD. Of the 50 iDTA patients, we deployed stent grafts above the celiac artery (Procedure 1), and we deployed the stent graft above the superior mesenteric artery with occlusion of the celiac artery in 8 cases of Crawford I TAAA (Procedure 2). For 35 Crawford II and III patients, we performed bypass oparation to connect the common iliac artery to visceral arteries before deploying the stent-graft (Procedure 3). For spinal cord protection, CSFD and dosage of naloxione was initiated during the operation and continued for 24 hours.
[Results] The success rate of EVAR was 100%. There was no death and only a single case of graft occlusion. Postoperative endoleak occurred in two cases in Type I and in one case in Type II. One case had acute renal failure. Furthermore, not a single patient exhibited paraplegia or paraparesis with CSFD and dosage naloxone for spinal cord protection. The freedom from aortic events rate was 87.0% at 5 years, and 83.3% at 7 years.
[Conclusion] EVAR of iDTA and TAAA with CSFD and dosage of naloxone might reduce paraplegia risk. Furthermore, these results indicated that maintenance of intraoperative collateral circulation to spinal cord might be important instead of reconstruction of intercostal arteries associated with postoperative paraplegia.